OVERNIGHT PARKING

Overnight parking is allowed at Alamance Community College to those who complete this form.

Please note that a Public Safety Officer is present overnight, but parking is at your own risk.

Please don't fill out this input box.

Requestor Information

First Name

Last Name

Phone Number*

Street Address*

City*

State*

Zip*

Was medical treatment required?*

Yes

Were you transported by EMS?

Yes

Public Safety Notified?*

Yes

Date and Time of Injury/Accident*

Date Injury Was Reported*

Emergency Contact Notified?

Yes

Name of Person Contacted

First Name*

Last Name*

Location of Incident

Part of Body Injured

Description of Accident

Are there any witnesses to the accident/incident? If yes, who?

Cause of Accident

Public Safety