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Medic Standby Request

  1. This form is only to be used by agencies who have contracted with the fire department for medic standbys. *Information submitted on this form will be sent via email. To protect sensitive information, do not include the following information on this form: Social Security numbers, driver’s license numbers, bank account information, routing numbers, medical information, passport numbers, and passwords.
  2. Indicate the date and time that this request is being made.
  3. Please indicate the time that medic personnel need to be in place at the event.
  4. Please include the first and last name of the contact person for this request.
  5. Leave This Blank:

  6. This field is not part of the form submission.