Event Services Request
Provided to you by Ontario Medical Response (a division of 1000826111 Ontario Corp).
Instructions
Please use this eForm to request our services for your event. Requests should be at least 2-4 weeks in advance to ensure adequate time for preparations.
Need Help?
If you encounter any issues with the form, please get in touch with us directly for assistance. (613) 532-6331 or by email at info@ontariomedicalresponse.ca
Back
Next
Requestor Details
Please indicate whom is making this request for our services.
Name of Requestor
*
First Name
Last Name
Company or Organization Affiliation
If this event is not associated with a company, leave blank.
Requestor Email
*
example@example.com
Requestor Phone Number
*
Please enter a valid phone number.
Mailing Address for Billing Purposes
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Preferred Contact Method
Please Select
Phone
Email
Back
Next
Event Details
Event Name
*
What is the name of your event?
Event On-Site Contact Person(s)
*
Who will our personnel connect with once on-site?
Telephone Number for Contact Person DURING the Event
Please enter a valid phone number that can be used to reach your on-site contact during the event.
Event Type
*
Please Select
Community Event
Sporting Event
Company Training Activity
Political Event
Entertainment
Charity/Fundraiser
Other
What category best describes your event?
Other Event Types - Specify Below
Tell us more about your event
Event Location (including street address)
*
Where is your event being held?
Is your event over multiple days?
Yes
No
Please enter your event schedule below (you may enter up to 5 days)
*
Event Date
Start Time
End Time
When to arrive?
When to depart?
Day 1
Day 2
Day 3
Day 4
Day 5
NOTE
Please specify above when you would like our team to arrive and depart from your event.
Event Date
*
-
Month
-
Day
Year
When is your event being held?
Event Start Time
*
What time is your event expected to start?
Event End Time
*
What time is your event expected to end?
Requested Arrival Time
*
When would you like our staff on-site?
Requested Departure Time
*
When would you like our staff to conclude and leave the event?
Weather Condition Planning
If your event has alternate dates in case of unfavourable weather, you may provide them here.
Will your event be dependent on weather conditions?
*
Yes
No
Do you have alternate dates in case of unfavourable weather conditions?
*
Yes
No
Please specify your alternate dates
Back
Next
Number of Event Medical Personnel Requested
*
Please Select
Unsure
2
3
4+
We require a minimum of 2 staff for any event
Estimated Number of Attendees/Participants/Spectators
*
How many people do you expect to attend your event?
Age Range of Attendees/Participants/Spectators
*
What age range do you expect to be present at your event (ex. Family-friendly event, 19+ Only event, Seniors 65+ event, etc...)?
Please select any amenities below that will be available on-site at the event
Electricity or Power Supply
Telephone or Cell Service
Radio Communication
Private Treatment Area or First Aid Room
Will There be Alcohol On Site (either served by the venue, or patrons can bring their own)?
*
Yes
No
Will Food/Refreshments be Available (or Sold) at this Event?
*
Yes
No
Are Restrooms Available at this Event?
*
Yes
No
Is this Request Being Made for Insurance Purposes?
*
Yes
No
Allied Agencies also Attending
Security
Police
Fire Department
Ambulance Service/EMS
Other
Optional - Event Map
Browse Files
Drag and drop files here
Choose a file
If available, please provide a map or diagram of your proposed event area
Cancel
of
Additional Information
Is there anything else you would like us to know about your event?
How Did You Find Us?
Google Search
Facebook
Instagram
Word of Mouth
Printed Material
Other
Disclaimer
This request form does not constitute a guarantee for services to be delivered. Your request will be reviewed within 1-2 business days. We will contact you within that timeframe to discuss next steps.
Submit
Please verify that you are human
*
Should be Empty: