Event Booking Form
This form will not guarantee cover for your event. This form allows us to gather the information to send you a quote based on the information you provided.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: 00000000000.
Address of Event
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date and Time Medical Team Required
*
-
Day
-
Month
Year
Date
Hour Minutes
Time Public Arrive
*
Hour Minutes
AM
PM
AM/PM Option
Time Public Depart
*
Hour Minutes
AM
PM
AM/PM Option
Nature of Event
*
Please Select
Public Exhibition
Non-Contact Sport Event
Contact Sport Event
Motorsport Event
Agricultural / Country Show
Village Fair / Community Event
Music Festival
Bonfire / Fireworks
VIP / Celebrity Visit
Equestrian Event
TV / Film / Media Production
Is your event following any guidance document
*
Run Britain, UK Athletics, Pony Club, BRC, BE, BS, Rugby Union
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Risk Assessment
I have used the online risk assessment and it scored
https://www.mwmedics.co.uk/event-medical-services-risk-calculator
Level of disorder
Low Risk
Medium Risk
High Risk
Opposing Factions Involved
Risk of Alcohol and Drugs
Low Risk
Medium Risk
High Risk
Type of Venue
*
Please Select
Indoor
Temporary Outdoor Structure
Outdoor, Confined E.g Park, Heras fenced
Outdoor Free Flowing
Widespread public locations E.g Multiple Streets
Stadium or Arena
Seated or Standing
Please Select
Seated
Standing
Mixed
Audience Profile
*
Please Select
Full Mix Family Groups
Predominately Children and Teenagers
Predominatley Elderly
Predominatley Young Adults
Full Mix Rival Factions
Expected Number of People on site
*
This should be number of people expected at any one time, not over the course of the day/ weekend
Medical Incidents Previously
*
Please Select
Low Casualty Rate
Medium Casualty Rate
High Casualty Rate
First Event, No Data
Additional Hazards
Street Carnival
Aircraft
Animal & Livestock
Weapons E.g Archery, Re-Enactment, Live Action Role Play
Martial Arts
Camping Onsite
Water Activities
Site Planning
No Access to Power
No Accsess to Running Water
Dedicated First Aid Room / Shelter Provided
Limited / Vehicle Access Including 4x4
Access only using 4x4
Medical Team Located on Soft Ground E.g Grass Field
What communication will be used on your event
Radios
Mobile Phone
Face to Face
External Communications Provider E.g Raynet
Other
Which Items do you require for your event
*
Cycle Responder
Response Vehicle
4x4 Ambulance
Road Ambulance
Medical Tent
Additional Medical Locations Required
Dedicated Medical Manager
Overnight Cover
Medical Plan
Im Unsure, please can you advise
Any other information we should know
File Upload
Browse Files
Drag and drop files here
Choose a file
Please upload any useful documents including maps
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of
Are there additional dates to your event?
Yes
No
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Second Date and Time Medical Team Required
-
Day
-
Month
Year
Date
Time Medical Team Required
Hour Minutes
Time Medical Team Expected Finish
Hour Minutes
Is there a third date to your event?
Yes
No
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Third Date and Time Medical Team Required
-
Day
-
Month
Year
Date
Time Medical Team Required
Hour Minutes
Time Medical Team Expected Finish
Hour Minutes
Further Dates and times
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Submit
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