Client Order Form Event Management

How Personal Contact Information Will Be Used

Privacy Notice*

We will need to share the below contact information to a third party as part of our booking process. We will store the contact's name and number for further reference, but at any time you can request for the contact's details to be deleted by emailing; data-protection@team-medic.com. Please tick the check boxes below confirming consent to share the Contact's personal information.

The contact details are mine (author) and I give you permission to share them to other third parties
I have obtained permission from the below contact who consents to their information being shared

Please confirm you have read accepted our Terms and Conditions*

Yes

CONTACT INFORMATION

Name of the Event*

Please give the name and phone number of the event contact person*

First Last

Phone*

Email*

ABOUT YOUR EVENT

Date of the event*

Time for medics to be operational*

Please state EXACT time you require the medics to be ready to go?

HH :

MM

Medic's Finish Time*

HH :

MM

Description of event*

please provide details of event

Onsite medical facilities*

e.g. first aid room, defib, stretcher, etc

If Yes, please describe

Is there access to FREE parking*

Yes
No

If Yes, please describe how to access parking

Address of the event venue*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Entrance points to the event*

Please provide specific info as to the entrance point to the pitch, venue, building etc.

Medic's location at event

Please describe where medic(s) will be located and access to the location.

Please indicate the number of people attending the event?*

Please indicate the number of people participating in the event?

Address of the nearest A&E*

Street Address Address Line 2 City County / State / Region ZIP / Postal Code Country

Hospital telephone phone number*

Are there toilet facilities?*

Yes
No

If Yes, please provide details.*

Is there access to ice?*

Yes
No

Are there any other activities at the venue?

Yes
No

If Yes, please provide details.*

Is there food and drink availiable at the event?

Yes
No
don't know

Type of event surface?*

Please upload any route maps or site plans if applicable

Drop files here or

Risk Assessment Report and any other information

Please upload your latest risk assessment report or any other information for the event.