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PAY A BILL | SATISFACTION SURVEY | PRIVACY POLICY

Account
- Store Dashboard
- Donor Dashboard

About
Events
Services
Training
Work at GEMS
- Job Openings
Explorer Post
Contact

0

Items : 0

Subtotal : $0.00

View Cart Check Out

Medical Stand-by Request

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- Step 1 of 3

Demographics

Name of organization requesting stand-by:

Name of representative requesting stand-by: *

First

Last

Email *

Email

Confirm Email

Cell Phone # *

Work Phone #

Mailing Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Stand-By Name & Type

Event Name *

Either provide the name of the event or a simple description of the event

Type of Event *

Sport Event
Community Event
Race Event
Public Event

Stand-By Location Information

Location of stand-by Address: *

Address Line 1

Address Line 2

City

State

Zip Code

Location must be within the Town of Greenwich

Stand-By Date Information

If this is a multiple day stand-by event please indicate the first and last day of the event.

Date (Start) *

This Event is Multiple days?

Yes

Date (End) *

Stand-By Time Information

Time of stand-by starts: *

Time of stand-by ends: *

Are the times the same for the other days?

Yes
No

Time of stand-by starts (Additional Days): *

Time of stand-by ends (Additional Days): *

Stand-By Additional Information

Organizational Tax status: *

For Profit
Non-profit

Is this a municipal agency in Greenwich?

Yes

Department or Agency

Number of attendees expected at event: *

Profile of participants (ex age groups, special needs, type of athletic event) *

Day of Event Contact Information

Primary Contact *

First

Last

Primary Contact Cell Phone# *

Additional Day of Contacts?

Yes

Secondary Contact

First

Last

Secondary Cell Phone#

Additional Information

Is this the first time you are having this event? *

Yes, this is the first year
No, we have done this before

Date / Time

Please provide any additional information about the event:

Greenwich EMS makes Greenwich a better place to live.

Email Us

Training information:
- training@GreenwichEMS.org
Volunteer inquiries:
- volunteer@GreenwichEMS.org
General inquiries:
- Info@GreenwichEMS.org
Billing inquiries:
- billing@GreenwichEMS.org

Emergencies

Always Dial 911 in an Emergency

Phone:

Main: 203-637-7505
Billing: 203-637-3000

© 2026, Greenwich Emergency Medical Service, Inc. (GEMS), 1111 East Putnam Avenue, Riverside, CT 06878 - Phone (203) 637-7505