Georgetown EMS Standby Request Form 
Georgetown EMS understands the importance of providing emergency medical services during special events or community programs and we strive to provide the highest standard of BLS care. In order for any organization to request special standby services from GERMS,  please accurately complete the following form and submit it to GERMS at your earliest convenience.

Following form submission and processing, GERMS will contact you with a proposal summarizing your request and all the provided information. After the proposal has been agreed upon, a final contract will be sent out. The contract must be submitted to GERMS at least 72 hours before the start of the event.

For any questions or concerns, please email the Director of Standbys .

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Email *
Name of organization requesting EMS services *
Name/Title of Event Requiring EMS Standby *
What type of support would you like? 

GERMS typically offers two main types of standby crews: First Responding Crew (2-4 EMTs, First Responding without an ambulance, Crew for $130/hour) and Transporting Crew (2-4 EMTs with an Ambulance for $200/hour). 

Please list the types and number of crews you would like. If your event does not fit the structure of the crews above, please describe the services you would like. 
 *
Is the organization affiliated with Georgetown University? *
Contact Email Address *
Contact Phone Number *
Location of the event *
Date of the event (mm/dd/yyyy) *
Start and End time of the event (0000-2400) *
Mailing Address (for final billing purposes)
Immediate questions or concerns? 
A copy of your responses will be emailed to the address you provided.
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