BVAC Standby Request Form
The Bergenfield Volunteer Ambulance Corps, Inc. (BVAC) understands the importance of providing EMS during special events or community programs. This Standby Request Form must be utilized in order to arrange any special EMS coverage. This form must be submitted to BVAC at least fourteen (14) calendar days prior to the event.

Although BVAC will make every effort to provide the level of service requested, Special Event coverage cannot be guaranteed due to the nature of EMS and the fact that the first priority of BVAC is to respond to 911 calls.

Organization name *
Your answer
Contact person name *
Your answer
Contact person e-mail *
Your answer
Contact person cell phone *
Your answer
Event contact person name (if Organization contact person will not be on site):
Your answer
Event contact person e-mail (if Organization contact person will not be on site):
Your answer
Event contact person cell phone (if Organization contact person will not be on site):
Your answer
Event name *
Your answer
Brief event description *
Your answer
Number of expected attendees (approximate)
Your answer
Event date *
MM
/
DD
/
YYYY
Event start time *
Time
:
Event end time *
Time
:
Any additional comments:
Your answer
By clicking "SUBMIT" below, you acknowledge that Special Event coverage cannot be guaranteed due to the nature of EMS and the fact that the first priority of BVAC is to respond to 911 calls.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service