HWS EMS Standby Request form


Contact Information:

Full Name:

Phone Number:

Campus Mailbox:



Event Information:

Name of Event:

Exact Location of Event:

Brief Description of Event:

Date(s) of Event:

Hour(s) of Event:

Number of Expected Attendants:

Number of Event Staff:

Any Known Medical Conditions:

Requested EMS Response:

Date(s) of EMS Presence:

Hour(s) of EMS Presence:

Number of EMTs needed:

Known Risks at Event:

Training/Equipment Required:

Ambulance Needed on site:

Is Advanced Life Support required?

Special Instructions/Other Important Information:



Kim Kochin
Student Activities Club Sport Adviser
Phone: (315) 781-3513


Preparing Students to Lead Lives of Consequence.