Your Name
*
Mr
Mrs
Miss
Ms
Dr
Prefix
First Name
Last Name
Company / Organisation
*
Business / Organisation Address
*
Building Name / No & Street Address
Street Address Line 2
City
Postcode
Postcode
E-mail
*
Confirmation Email
Main Contact Number
*
Please include the area code eg. 020 8446 9341
Mobile Number (optional)
Please include the area code eg. 020 8446 9341
Is the address where medical cover is requested the same as the business address above?
*
YES
NO
Location of event requiring medical cover
*
Building Name / No & Street Address
Street Address Line 2
City
Postcode
Postcode
What is the maximum number of participants attending the event?
*
Please include any students, spectators and/or staff for whom medical cover may be required
Date & Timings
*
Not Yet Known or To Be Confirmed (any quotation will be based upon a full day rate within North London)
Details Known (Please complete details below)
Event Date, Start Time and End Time
*
Who is the first aid or medical cover for? (please select one or more of the following)
*
Children (under 18 yrs old)
Adults (18 yrs old or over)
Are you or any other third party providing additional first aid or medical cover in addition to services requested from ourselves?
*
YES
NO
If YES, please give details of any additional first aid or medical cover being provided (eg. School Nurse, First Aiders etc.)
*
For which type of event do you require first aid or medical cover?
*
School Sports Day
Sports Fixture
Festival / Outdoor Event
Concert / Indoor Performance
Work / Private Function
Religious Festival
School Medical Room
Youth Group / School Day Trip
Youth Group / School Residential Trip
Other
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First Aid & Medical Cover
for Events and Activities
Is alcohol available on site to participants prior to or during the event or the period of time for which medical cover is requested?
*
YES
NO
Are you able to provide a designated treatment area (such as a private room or tent) throughout the event?
*
YES
NO
Do you authorise First Aid Medical Services staff to administer non-lifesaving medication to children in your care, on your Company's behalf, where appropriate parent/guardian authorisation has been obtained?
*
YES
NO
Our staff will only consider the administration of non-lifesaving medication to a child where the criteria set out in our Terms and Conditions are fully met. Please confirm the following:
*
I will obtain sufficient written confirmation from each child's parent/guardian prior to authorising First Aid Medical Services staff to administer medication to that child on behalf of my Company and/or the child's parent/guardian.
Are you able to provide First Aid Medical Services appropriate access to any child's medical records held by your Company, if required for medical assessment and treatment?
*
YES
NO
Will you have an appropriate adult chaperone available to accompany a child, if required for a patient examination?
*
YES
NO
Is food and water available to our staff and any patients throughout the event? (Please select one or more of the following)
Water provided to staff and patients free of charge
Water available to purchase only
Food provided to staff free of charge
Food available to purchase only
Does your event risk assessment or licence specify a particular number of responders / medics of specific clinical grade (eg 1x paramedics, 2 medics, 4 first aiders, one ambulance etc.)
*
YES
NO
If YES, please give details below
*
Please tick if any of the following activities are to be undertaken by participants at the event
Motorsports of any kind
Cycling (or similar, eg. skateboarding etc.)
Rugby
Contact Sport (eg. karate, boxing)
Road racing (whether 'off road' or 'on road')
Cross Country or other activity (beyond a central location)
Working at height
Horse riding
Other
Please give full details of the event, including any activities to be undertaken by participants (eg. sports day with 1000 students aged between 11-18yrs, multiple running races, high jump, javelin, taking place in a central location. A future 1000 spectators in seated stadium)
*
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First Aid & Medical Cover
for Schools & Youth Groups
Is first aid or medical cover requested for daytime only or a residential setting?
*
Daytime Only
Residential Setting (ie. daytime and nighttime)
Do you authorise First Aid Medical Services staff to administer non-lifesaving medication to children in your care, on your Company's behalf, where appropriate parent/guardian authorisation has been obtained?
*
YES
NO
Our staff will only consider the administration of non-lifesaving medication to a child where the criteria set out in our Terms and Conditions is fully met. Please confirm the following:
*
I will obtain sufficient written confirmation from each child's parent/guardian prior to authorising First Aid Medical Services staff to administer medication to that child on behalf of my Company and/or the child's parent/guardian.
Are you able to provide First Aid Medical Services appropriate access to any child's medical records held by your Company, if required for medical assessment and treatment?
*
YES
NO
Will you have an appropriate adult chaperone available to accompany a child, if required for a patient examination?
*
YES
NO
Are you able to provide a designated treatment area (such as a medical room) as required?
*
YES
NO
Is food and water available to our staff and any patients throughout the event? (Please select one or more of the following)
*
Water provided to staff and patients free of charge
Water available to purchase only
Food provided to staff free of charge
Food available to purchase only
Please give full details of your first aid or medical cover requirement (eg. to cover the first aid and administration of medication and to cover the medical room within the Senior School, for 1000 students aged between 11 and 18 years old). Please include any higher risk activities that may be undertaken by participants / students (eg. archery, wide-games, horse riding etc.) that fall outside of a typical school day.
*
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