408 E WhitmanPocatello, ID 83201
208-234-6201
To request ambulance standby for your upcoming event, please fill out the form below. The fee is $170 per hour with a 2‐hour minimum. You will need to calculate the total number of requested standby hours and specify the ambulance arrival and departure times for each standby session.
Name
Address
Contact Person at Event
Number of Ambulance Standby Sessions Requested
Ambulance Standby Date
Session 1 - Ambulance Standby Date
Session 2 - Ambulance Standby Date
Session 3 - Ambulance Standby Date
Session 4 - Ambulance Standby Date
Session 5 - Ambulance Standby Date
Please upload a file with a detailed schedule of the requested ambulance standby. Below is an example of the information needed.
Total Hours of Ambulance Standby: 15 hours
Ambulance Schedule
Requestor agrees that EMS personnel providing service shall not be charged admission or entry fee to event.
Requestor agrees to pay $170 per hour with a 2‐hour minimum (pursuant to Resolution No. 2016‐71) for each unit furnished. Travel time to and from event location will be included in the total hours invoiced. Cancellation must be made with a minimum of twenty‐four (24) hours’ notice; failure to cancel will result in a cancellation fee. A deposit for the estimated cost may be required before the event, pending review of application. Balances remaining after 90 days may be sent to BCAD’s collection agency.
Estimated Cost
Payment Method
To apply for a fee waiver, you must submit a Request for Ambulance Standby Fee Waiver form in addition to this form at least 30 days before the scheduled event.
Signature
