Required fields are marked with asterisks (*)

Fire and Paramedic Education Tours and Requests

Contact Information

Name

Phone

Please provide principal's name for any school applications

Event Information

Name of your event

Select the type of event that you are organizing

Safety education/awareness event

Open house or welcome event

Community festival

Other

Select the type of truck/service you would like to request

Fire Truck - Haldimand County Fire Services

Ambulance - Haldimand County Emergency Services

Address

Town/City

Postal code

Select your event date

Select an alternate event date

Select the time frame you'd like the truck to arrive

9 to 10:30am

1 to 3:30pm

6 to 7:30pm

Flexible

Describe the main purpose of your event

Describe what you hope to accomplish by having a fire truck or ambulance at your event

Is there any other important information we should know about your event?

Personal information is collected under the authority of the Municipal Freedom of Information and Privacy Act and will be used for candidate selection purposes only. This application form complies with the Ontario Human Rights Code.

For questions regarding this application, please contact Emergency Services Headquarters at 905-318-5932, ext. 6224 or by e-mailing emergencyservices@haldimandcounty.on.ca