Brentwood Legion Ambulance
Observer Authorization
This Document Serves As Authorization For The Observer Indicated Below To ride As An Obsrver On Any Brentwood Legion Ambulance Service Ambulance During The Hour Indicated Below Providing
The Signature of The President of Brentwood Ambulance is Affixed To This Document
The Request For The Observer To ride Is Made By a Member In Good Standing Who Is Currently An Active Badge Member of Brentwood Ambulance
The Observer Rides Only Between The Hours of 0900 and 2400 Hours, and The Period Indicated Below, and Then Only With At Least Two Riding Badge Members, One of Whom Is At Least an EMT
The Observer Can Produce This Document When Requested By An Office of the Corps or The Crew Chief
Observer Name:
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First Name
Last Name
Signature:
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Date:
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Requester Name:
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First Name
Last Name
Signature:
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Date:
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Month
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Date
President's Signature:
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Date:
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Month
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Day
Year
Date
Date of Tour:
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Month
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Day
Year
Date
Time of Tour From:
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Time of Tour To:
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Enter the Message As It's Shown:
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Submit
Should be Empty: