Kent County Dept. of Public Safety - Division of Emergency Medical Services

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Event Coverage Request Form

Please complete the following section with your event and contact information.
Requests within two (2) weeks of event will not be guaranteed dedicated coverage.
Please allow 2 business days for processing.
If you do not hear from us within two business days, please call 302-735-2180

Event Name *

Location of Event *

Event Date *

YYYY

Event Start Time *

Time

Event End Time *

Time

Rain Date?

Please indicate Rain Date. If no Rain Date is an option, please leave blank.

YYYY

Point of Contact (POC) *

POC Phone Number *

POC email address *

Event Type *

Choose all that apply

Medical Stand-by / coverage

Static Display

Presentation on EMS / Paramedics

Educational Request

Other:

Required

Special Equipment Requested

Bike Medics

CPR demonstration

Other:

Educational Request

CPR

First Aid

Narcan Training

Active Shooter

Other:

Anticipated Attendance - Spectators and participants *

Any other information not covered with above questions?

Submit

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