The Galloway Township Ambulance Squad also provides stand by crews for any kind of event: sports, large conferences,  graduations, festivals, etc.  Whether you would like 1 EMT to stand by as a 1st responder or 2 EMT's with an ambulance, we can fulfill your needs.  Either fill out the form below and click on submit or print out the form and fax it to (609) 804-0332.  Please submit your request at least 10 days in advance.  If you do not get a conformation on receiving your request within 24 hours, please contact us at (609) 457-2684 or (609) 965-4046.  Thank you.

 

Request For EMS Coverage

Please provide the following information:

Organization Requesting EMS Coverage: *
Person/Title Requesting the Stand By: *
Phone #: *      Fax #:     
E-mail (optional):
Date of Stand By: * Start Time: *     End Time: *
Location of Stand By: *
Reason For Stand By: *
Contact Person at the Stand By: *

Choose one of the following options:*

One EMT                           $30/hr
Two EMT's & Ambulance      $60/hr
Other:

Please provide the following billing information:

Name: *
Title: *
Organization: *
Street Address: *
Address (cont.):
City: *
State: *
Zip Code: *

*Required

 
   

This site was last updated 10/30/06