Event Medical Cover Enquiry Form
Organiser Details
Your Name
*
Organisation / Company Name
Address
*
Contact Telephone Number
*
Contact Email Address
*
Event Name
*
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Event Details
Event Location
*
Medical Cover Start Date and Time
*
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Day
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Month
Year
Date
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Hour
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10
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Minutes
AM
PM
AM/PM Option
Medical Cover Finish Date and Time
*
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Day
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Month
Year
Date
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4
5
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Hour
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10
20
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40
50
Minutes
AM
PM
AM/PM Option
Specific Activities Taking Place
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Event Website
Estimated Number of Participants
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Estimated Number of Spectators
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Estimated Number of Event Staff
*
How will they be accomodated?
*
Standing
Seated
Mixed
Who is the event aimed at? (Please select all that apply)
*
General Public (On The Day)
Ticketed Guests Only
Mainly Under 18’s
Mainly Young Adults
Mainly Middle Aged Persons
Mainly Older Persons
Family Groups
Groups (Not Family Groups)
Are any other organisations involved in the provision of Medical Services to this event?
*
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On The Event Day
Who do our team report to on the day?
*
What is their contact number?
*
Is there a facility available for treating casualties in private?
*
Is Free Parking available to our team?
*
Is Fresh Water available to our team?
*
Is Food available to our team Free of Charge?
*
Please detail the medical resources you feel are required for your event
*
Please detail any further supporting information
*
Upload supporting information
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Declaration
By signing this form, I understand that I am requesting a quotation for the services of Waterside-EMS. I acknowledge that completion of this form does not constitute a firm booking. I have completed this form with correct information to the best of my knowledge and will undertake to inform Waterside-EMS of any changes to the information. I have read and will comply with Waterside-EMS standard Terms and Conditions. *I will forward all relevant documentation to Waterside-EMS, including Risk Assessments, Site Plans and Emergency Escalation Plans.*
I Agree
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