Do I need a notary for the Special EMS Service Request Agreement?

No. The document has a responsible-party signature line but no notary block or notarized attachment; the signer signs and dates the request.

How do I submit the Special EMS Service Request Agreement?

Return the completed and signed agreement to Curtis Ward by email, fax, or mail using the contact details printed in the document.

What information does the agreement ask for?

It asks for event dates, times, location, type and estimated attendance, potential concerns, requester and billing details, and requested EMS units and standby times.

When should I send in the agreement?

The document says to return it at least 96 hours before a single event. Extended, multi-day, or large events requiring more than one ambulance should be arranged at least ten days ahead.

Hampton, VA · City of Hampton

No notary required

Special EMS Service Request Agreement

Organizations and individuals use this agreement to request dedicated or non-dedicated Hampton Division of Fire and Rescue EMS standby coverage for an event.

What this form is

Use this agreement to request special EMS standby coverage from the Hampton Division of Fire and Rescue for an event or community program. It asks for event details, requester and billing information, requested units and standby times, and whether the event meets the specifications for non-dedicated coverage. The document says single events should be submitted at least 96 hours ahead; extended, multi-day, or large events requiring more than one ambulance should be submitted at least ten days ahead.

Who needs it

An organization or individual requesting special EMS standby services from the Hampton Division of Fire and Rescue should complete and return this agreement.

How to submit it

Return the completed, signed agreement to Curtis Ward by email at [email protected], fax at 757-727-1207, or mail to Hampton Division of Fire and Rescue, ATTN: EMS and Special Events, 1300 Thomas Street, Hampton, Virginia 23669.

About notarization

This document is signed without a notary; the responsible party signs the request, and the agreement requires no notarized or sworn attachment.

How to submit this form

1
Download The Agreement
Download the Special EMS Service Request Agreement PDF.
2
Complete The Request
Enter the event, requester, and billing details, then select the requested standby service and provide unit and time information.
3
Review The Agreement
Review the applicable coverage terms and sign the request. Attach an additional schedule if requesting more than three units.
4
Send It To HDFR
Return the signed agreement to Curtis Ward by the email, fax, or mailing address printed in the document.

Frequently asked questions

Do I need a notary for the Special EMS Service Request Agreement?: No. The document has a responsible-party signature line but no notary block or notarized attachment; the signer signs and dates the request.
How do I submit the Special EMS Service Request Agreement?: Return the completed and signed agreement to Curtis Ward by email, fax, or mail using the contact details printed in the document.
What information does the agreement ask for?: It asks for event dates, times, location, type and estimated attendance, potential concerns, requester and billing details, and requested EMS units and standby times.
When should I send in the agreement?: The document says to return it at least 96 hours before a single event. Extended, multi-day, or large events requiring more than one ambulance should be arranged at least ten days ahead.

Need something notarized?

This Special EMS Service Request Agreement doesn’t need a notary — but if you have another Hampton form that does, a commissioned online notary can help.