EMS Event Standby Request

EMS Event Standby Request
Thank for your interest in having the Lakeside Volunteer Rescue Squad help with your event. Please know, Lakeside Volunteer Rescue Squad does not directly charge for its services however, donations are always appreciated.

NOTE: By completing this form it in no way guarantees that the Lakeside Volunteer Rescue Squad will be able to staff your event. This form is only used as a way to gather detailed information about your request. We will try our best to accommodate your needs but please know that we cannot guarantee this in every situation due to our size and commitment to providing our 911 services before any other.
What is the name of your organization or business?*
Name of requestor *

First NameLast Name
Phone Number*
Please enter a valid phone number.
Best time to call *

Hour Minutes

AM/PM Option

Until
until
Hour Minutes

AM/PM Option
Email*

Confirmation Emailexample@example.com

The Details
Date of event and event start time:*

MonthDayYear
Date
Hour MinutesAM/PM Option
Estimated time your event should end:*

Hour Minutes

AM/PM Option
Estimated attendance: *
What time do you need the crew to arrive? *

Hour Minutes

AM/PM Option
Where will your event be held? Please include the business name*

Business Name

Street Address

CityState / Province

Postal / Zip Code
Will your venue be indoor, outdoor, or both?*

IndoorOutdoorBoth
Is this location outside of Henrico County? If yes, please choose the location.*

NoCity of RichmondHanover CountyChesterfield CountyOther

Minor Additional Information
Where would you like the crew to park?*
Will water be available for the crew while at the event?*

YesNo
Will food be available for the crew while at the event?*

YesNo
Will your organization be making a donation to Lakeside VRS for this event?*

YesNo
Donations are not required, but are thoroughly appreciated and help cover equipment costs. Recommended donations range from $200-1000 based on number of units and providers needed and the length of the standby.

Donations can be made by cash, check, or credit through PayPal. Please see our Donations page for more information.
Who should the crew contact or meet with when they arrive?*
What is the onsite person's phone number?*
Please enter a valid phone number.
Do you have a deadline for when you need coverage confirmation? If so, put in date. If not, put N/A.
Does the event have a website? If yes, please enter the address.*
Do you have any other information we may not have asked about but you feel is important?*
Should be Empty:

The Details