Sedgwick County EMS Ride-Along Request
Thank you for your interest in riding along with Sedgwick County EMS.
This form is for adult riders only. If you are between the ages of 16 and 18, please have your parent/guardian reach out to Kyle Burtch (kyle.burtch@sedgwick.gov) to discuss the steps to getting you set up. 

We have a few steps to take before we can get you signed up for a ride-along. 

1. Watch the EMS rider orientation video

2. Watch the HIPAA training video

3. Fill out the required information on the form

4. Submit to a background check. This will cost $18 (it will be emailed to you from Sterling Volunteers after you complete the form below). If you have questions about the background check process, please reach out to victor.okwo@sedgwick.gov. 

5. Sign up for a time to be fitted for a N95 respirator to ensure your safety on the ride along. 
-This will be scheduled at 1015 Stillwell St, Wichita, KS 67213.
-Fitting can only be scheduled after you have completed steps 1 - 4. 
-If you have an N95 mask you have already been fitted to
         - reach out to kyle.burtch@sedgwick.gov on the conditions for acceptance.

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EMS Rider Orientation Video
I have watched the EMS Rider Orientation video *
HIPAA and Social Media
HIPAA Document
HIPAA Document
HIPAA Document
HIPAA Document
I have viewed and understand the HIPAA video and documentation  *
First Name *
Last Name *
Age (Riders under 18 will have to have a guardian sign for them)
Email *
Phone Number (numbers only)  *
Why do you want to ride-along with Sedgwick County EMS?
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