Special Events Form

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Request for EMS

Please correct the field(s) marked in red below:

Thank you for your interest in special event coverage from Victoria Fire Department. This form must be completed in full for consideration by Victoria Fire Department at least (15) days prior to the event.

 

Victoria Fire Department will determine whether coverage will be offered, and if so, will determine which EMS
resources will be used. If coverage is offered, you will be given confirmation along with an estimated cost.

Event Information

1
Resource Type Requested:
Resource Type Requested:
2
Event Date:
3
Event Name:
4
Event Location (address or venue):
5
Event Type (e.g. 5K run, soccer, football game):
6
Estimated Event Crowd Size:
7
EMS Report Time:
8
Event Start Time:
9
End Time:
10
What specific location on the property should the EMS unit be placed?
11

Contact Person and Telephone # for event:

12
Map:

Maps of the course or venue are required and must be returned with this form unless the
venue is a permanent sports or entertainment facility.

Billing Information

13
Company/Group Name:
14
Responsible Individual:
15
Billing Address:
16
City/State/Zip:
17
Telephone:
18
E-Mail:
19
SSN or Tax ID #:
20
Any additional information you would like to provide regarding this event:

Factors used to determine whether/how coverage will be offered may include: event crowd size (1500+), risk factors for participating population, EMS access to venue (area traffic impedance), FIRE/EMS availability and event impact on 9‐1‐1 operations.

EMS coverage is intended for individual patient evaluation, treatment and/or transport to an emergency  department. It is not intended for, and it is beyond the scope of EMS to provide “first aid station” type services, for example: pain medicine for headaches, multiple ice packs or elastic bandages, other medical supply hand‐outs, bottled water, etc.

Hourly fees are set by the City of Victoria. There is a 2‐hour minimum, and 2 or more resources require the addition of a EMS Supervisor to oversee event operations.

Payment for services are due one business day prior to the start of the scheduled event. Payments can be made at the City of Victoria Finance Department Office.

Ambulance: $95/hr

EMS Bike Team: $75/hr

EMS Supervisor: $50/hr

  1. To receive a copy of your submission, please fill out your email address below and submit.