EMS Special Event Request Form

Guidelines for Medical Standby and Special Event Requests

Types/Categories of Events

When completing the online request form, you will be required to choose from the following categories that best describes your event:

Medical Stand-by:
This event involves having an ambulance staffed by EMS personnel for medical coverage at your event for emergencies that may arise. There are two categories to select from:

PAID Medical Stand-by:
If you charge admission for your event then our services would fall under this category. You will need to fill out the registration request and someone will be in contact with you to discuss providing medical coverage and our availability to schedule your event. Our current hourly stand-by fees are published in the request form below.

NON-PAID Medical Stand-by:
If you are not charging admission into your event then our services would fall under this category. You will need to fill out the registration request and someone will be in contact with you to discuss our availability to schedule your event.

Community Relations, Educational, and Other Special Event Requests:

Career Day:
(High Schools, Community Colleges, Colleges and Job Fairs)
This event would involve EMS personnel coming and speaking about EMS as a career.

Community Relations (PR) Events:
(Show-n-Tells, Health Fairs, Schools, Presentations, Speakers Series)
This event involves show casing EMS services. This event may or may not involve having an ambulance present at the event. (Please note on the request form if having an ambulance present at the event is a requirement so it can be taken into consideration as we process your request).

General Guidelines for a Successful Event or Medical Standby include:

-Due to staffing and scheduling challenges, pre-planning will be vital to a successful event.

-Please be advised that staffing may be limited for special events during holidays and weekends.

-EMS reserves the right to decline a PR Event, or to cease our participation in an event due to staff or participant safety concerns.

-All event requests must be received by Union EMS at least 7 days prior to the event. Your request will be reviewed based on prior commitments/events and availability of EMS Staff.

-Events work best that are no longer than a 4-hour time commitment, depending on the location

-Please be advised that should an emergency arise, due to the nature of our business, the staff and ambulance may be called into service.

-The sponsoring Agency/Business is required to provide at least one responsible person on-site during the entire event. This person will act as the liaison with Union EMS Personnel and event staff during the event. The EMS Personnel will need the person’s name and contact information before the event for scheduling purposes and the day of the event for coordination. (Please note this information will be required on the request form and shared with the EMS staff attending the event as well as the on-duty EMS Supervisor(s).

Please fill in the required information below and click the submit button. Your request will be forwarded to the appropriate EMS Administrative Personnel for review and approval.

ORGANIZATION INFORMATION

Requesting Business/Organization Name *

Address *

City *

State *

ZIP *

Primary Phone *

Fax Number

Company/Organization Website (if applicable)

Event Coordinator's Contact Information

First Name *

Last Name *

Primary Phone *

Alternate Phone *

Email Address *

EVENT INFORMATION

Event Type * 🛈