EmailMeForm
Helicopter and Ambulance Request
Complete this form to request the presence of the Ambulance or Air Care team or vehicle at an event, training or other educational purpose.
Today's Date
MM
/
DD
/
YYYY
Requesting Organization
*
Event Date Time
MM
/
DD
/
YYYY
HH
:
MM
AM
PM
AM/PM
Name of Event
*
Event Location
*
Duration of Event
*
hours
Contact Information
Name
*
First
Last
Phone
*
###
-
###
-
####
Email
*
Nearest Street Address to Event
*
Street Address
City
State / Province / Region
Postal / Zip Code
Vehicle Preference
*
Helicopter
Ambulance
Both
Other
Type of Request
*
Static Display
Fly-Over
Landing Zone Class
Helipad Pad Safety
Other Education
Landing Zone Information
Latitude
Longitude
DD.DDDDD
Latitude: 45.014595
Longitude: -93.320449
-or-
DD MM' SS"
N 45° 00' 52.5"
W 93° 19' 13.6"
Nearby Hazards?
On-Scene Agency
County or Dispatch Center
*
Radio Frequency for Landing Zone
Landing Zone Safety Contact Name
First
Last
Landing Zone Safety Contact Phone Number
###
-
###
-
####
Landing Zone Photo
(if available)
Additional File
(if applicable)
Instructor Needs to Bring
*
Computer/Laptop
Projector
Screen
Nothing, we have all
Other
Special Requests or Other Information
Landing Instructions
- Designate assigned radio channel with dispatch & establish contact with North Memorial Health Air Care
- Secure 100' x 100' minimum flat surface, locate and announce any obstacles (wires, towers, poles, etc.)
- Maintain a secure landing zone until after departure
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