Eclipse Government

Name: First Last
Phone: ###-####

Job: Rank/Role
Criminal history: Short explanation
((Timezone relative to UTC)): UTC+2

By signing this form, you agree to the following terms and conditions:

• I will not interfere with the EMT doing their job.
• I will listen to the EMT's instructions at all times, unless it is to assist in their work.
• The EMT can stop the ride-along at any point at their own discretion.
• I will not bring any weapons.
• If I get injured, the LSEMS can not be held responsible, unless gross misconduct led to the injuries.
• While on scenes with police involved I will remain in the ambulance and will not communicate with anyone.
• I will show I possess common sense.

Signature:
Kevin Nostner

Dear Mr. Nostner,

Thanks for your ride-along request!
I'm Senior Paramedic Stefanie Huth with the LSEMS and I am contacting you to schedule a ride-along.

Please let me know, when you would be available and in what kind of time frame.

((please edit your "name" and your "phone number" and possibly "job"))

Sincerely,

Senior Paramedic Stefanie Huth