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Frontenac Paramedic Service

2069 Battersea Road Glenburnie, ON. K0H 1S0

Phone: 613 548-9400

Event Name:

Venue Name:

Venue Address:

Event Date

Event Start Time

Event End Time

Approximate number of attendees:

Approximate age range of attendees:

Do you have an existing contract with the County of Frontenac/Frontenac Paramedics

Yes

Time Paramedics are required on site:

Time Paramedics can leave:

Will Paramedics be dedicated to one group (only required to respond to event staff, performers, ect.)?

Name of person organizing Paramedic Coverage

Contact Phone Number

Contact Email

Organization or Person to be Billed:

Billing Address

Billing Email

On-site contact name for date of event:

On-Site contact phone number

Where will the ambulance be able to park?

General Comments

Would you like a copy emailed to you?

Yes

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