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2. 
3. Instructions

   When filling out this form, you will be required to include you school, business, or personal email. When requesting the ride along please reference the ride along google sheet, that sheet will include the required information needed to fill out this request form. You will also have waivers to sign that will be provided at a later day and time. If you have any questions after filling out this form, please contact our Franklin County EMS representatives at

5. Are you a student?*

   1. Yes
   2. No
6. If answered yes, please provide your name, school email address, school, and if this for a class, what class it is for.*

   Please separate your email, school, and class by commas or enter them each on a new line. If you don't have some of the information needed, leave it blank.

8. Is this for personal experience?*

   1. Yes
   2. No
9. If answered yes, please provide your name, email address, and phone number that is the best way to contact you.*

   Please separate the email and phone number by either a comma or on a new line,

11. If answered no to both questions above, please give us a reason for the ride along request.*

    Just give us an explanation as to why you are requesting a ride along.

13. Ride Along Date*

    Please provide the date for the requested ride along.

14. Ride Along Station*

    Please provide the station for the requested ride along.

15. Ride Along Shift*

    Please provide the shift for the requested ride along.

17. Request Start and End Time*

    Please provide the start and end time you would like to have, every ride along has a 4-hour minimum. NOTE: Sometimes the requested start and end time is not possible however we will attempt to get as close as possible to the requested time.

18. Contact Time*

    Please list the best days and times to contact you via phone if needed.

20. Additional Comments

    Please list any more comments or concerns that the EMS trainers should know in the text box above.

Leave This Blank:


22. 1. Receive an email copy of this form.
23. Email address

    This field is not part of the form submission.

24. Submit

* indicates a required field