Catapult Services Ltd Medical Event Cover Booking Form

Catapult Services Ltd Medical Event Cover Booking Form

Book us for your next event - quality medical cover at fair prices. Any questions, please get in touch: 020 3384 7876.
Name of person submitting booking*

First NameLast Name
E-mail*
Landline phone Number*

Area CodePhone Number
Mobile phone Number - for us to contact you to ask any questions

Area CodePhone Number
Event name
Location of the event

Building name

Street Address

CityState / Province

Postal code
To find the what 3 word for the location of the event, follow the steps below:

How to find the what 3 word location

Please then enter the what 3 word location in the box below.
What 3 Word location
Times medical cover required:
Start date & time of event *

DayMonthYearHourMinutes
End date/time of cover required *

DayMonthYearHourMinutes
Please give details (dates and times) of any additional cover not detailed above.
Details about the cover required

Please use the selections below to provide details about your event - we will be in contact with you shortly after submission of the form to confirm details.
Film / TV setPrivate event not listed elsewhereClassical music performancePop/rock concertMusic festivalSporting eventPublic exhibition (art fare or similar)Agricultural/country showVillage show (or similar)Activity involving marine environmentMotor vehicle displayActivity involving aviation - like air showMotor sport eventpublic displayNew Year celebrationsLow risk Demonstrations/marches/political events
IndoorSports venue or sports fieldOutdoor in confined location - eg parkOther outdoor - festivalWidespread public location in streetsTemporary outdoor structures
Full mix, in family groupsFull mix, not in family groupsPredominately young adultsPredominately children and teenagersPredominately elderly peopleAdults (TV / FILM)Work related event (private event
Good data, low casualty rate previously (less than 1%) [0]Good data, medium casualty rate previously (1% - 2%) [1]Good data, high casualty rate previously (more than 2%) [2]First event, no previous data [3]
Less than 500 peopleUp to 1000 peopleUp to 2000 peopleNo more the 3000 peopleBetween 3000 and 5000Between 5000 - 7000 peopleBetween 7000 - 10,000 peopleOver 10,000 people
No queuing time the event is open accessLess than 10 minsUp to 20 minsUp to 60 mins2 Hours or more
AlcoholCarnivalHelicoptersMotor SportsParachute DisplayFireworksStuntsOther (Please state)
Any additional information:
Will you have security at the event?
Have you had contact with the Safety Advisory Group (SAG)
Should be Empty: