Request Niagara's Paramedics for your Event

Use this form to request our paramedics attend your special event.

We cannot guarantee attendance. After you submit this request form, we will contact you regarding your event.

Call us at 905-984-5050 ext. 2859 for further information.

Request Form

* = Required

Applicant Information

* Name

Organization name

* Address

* City

* Postal code

Event Contact Information

I'm the event contact

Event contact name *

Phone * xxx-xxx-xxxx Ext.

Fax

* Email

Event Information

* Name

* Date

* Start time : Specify a time

* Address

* City

Description of event

# of people attending (approximate)

Other community partners (fire, police, agencies) will be present

Event Expectations

Describe what our role will be at your event

Describe any special equipment/materials you would like us to bring

Notice of Collection

Any personal information or personal health information submitted will be collected, used, and disclosed, where applicable, by members of Regional staff according to the Municipal Freedom of Information and Protection of Privacy Act or the Personal Health Information Protection Act. Any information you share will only be used for the intended purpose for which it was provided.

For questions or comments about privacy practices, or for more information about the administration of the Municipal Freedom of Information and Protection of Privacy Act in Niagara Region programs, see Freedom of Information and Open Government.