Booking Request

Booking Enquiry Form

Once we receive the filed form, we will contact you shortly to confirm availability.
Name of Organisation/Group
Name of Applicant

First NameLast Name
Phone Number
Format: (000) 000-0000.
E-mail
example@example.com
Event Name
Event Location

Street Address

Street Address Line 2

Town/CityCounty

Eircode/Loc8 code/What3Words Location
Event Date

DayMonthYear
Event Start Time

Hour Minutes

AM/PM Option
Event Finish Time

Hour Minutes

AM/PM Option
Please note: Duties of 3 hours or more must include a light meal (e.g. Tea/coffee or soup and sandwiches), duties of 5 hrs. + a more substantial meal is required to be provided by the organisers of the event for the volunteers
Site Contact (if different than above)

First NameLast Name
Site Contact Phone Number (if different than above)
Please enter a valid phone number.Format: (000) 000-0000.
Nature of Event

Other
Is your event being run for the benefit of a registered charity?
Charity Name
Please Note: For events on the public road please note that the Gardai must be informed.

If you have been in contact with the Gardai please indicate the name of the Garda and the Station informed.
Name of Garda

First NameLast Name
Name and Phone Number of Garda Station
Event Safety Plan and Insurance MUST be current and in place and may be requested for inspection by Civil Defence before the event or on the day of the event
Insurance Policy in place
Insurance Policy

Cancelof
Safety Plan for the event in place
Safety Plan

Cancelof
Route Map or other relevant attachments

Cancelof
First Aid Duty
Type of Assistance Required
Number of First Aid teams requested
A team consists of 3-4 people and is not counted as an Ambulance
Is an ambulance required
How many Ambulances do you estimate you require
An Ambulance will contain a minimum of 1 EMT and 1 First Aider/Driver
Designated location for First Aid/Ambulance
Will a Doctor be available
Name of Doctor

First NameLast Name
Phone Number of Doctor
Please enter a valid phone number.Format: (000) 000-0000.
I/We agree to indemnify Galway County Council and Civil Defence against any claims for loss or damage resulting from involvement in this event and I understand that in the event of Civil Defence Service committed to this activity being required for an Emergency Situation elsewhere service may be withdrawn without notice and without replacement.

If Galway Civil Defence believes the Event is not being organised as required in the detailed plans or if the basic requirements are not being adhered to operate the event in a safe environment, the Galway Civil Defence volunteers will withdraw their services immediately.

I/We agree to mention Galway Civil Defence in all publicity associated with this event.

On behalf of the above organisation I wish to make formal application for Civil Defence Assistance as per the details outlined above.
Signature on behalf of the Organisation/Group

If blank, contact details from above will be used as proof that information entered is correct, and that the 4 conditions/terms above are agreed to.
Should be Empty:

Booking Enquiry Form

First Aid Duty