Equipment Request

Request loaned equipment from Millstadt Ambulance Service for a community event, training, or program.

Equipment availability is limited. A coordinator will reach out to confirm what we can provide and review any usage requirements.

Requestor Information

First Name *

Last Name *

Phone *

Email *

Organization (if any)

What's Being Requested

Item Requested *

AED (loan / event use)CPR Training MannequinStop the Bleed KitBlood Pressure CuffStandby / Event First Aid KitOther (describe below)

Purpose *

Community EventSchool / ClassroomWorkplace TrainingSports / Athletic EventFaith / Civic GroupOther

Date Needed *

Return Date

Quantity

Where Will It Be Used

Additional Details

Acknowledgment

I understand that Millstadt Ambulance Service equipment is operational property that may be recalled at any time for emergency response. I agree to return all loaned items in the same condition received, and accept responsibility for any loss or damage that occurs while in my care.

All equipment loans are subject to availability and a signed usage agreement. Items must be returned in the same condition and may be recalled if needed for emergency operations.

Millstadt Ambulance Service

Millstadt, Illinois

Providing advanced life support and emergency medical services to Millstadt and surrounding areas since 1980.

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Contact

100 E Laurel St
Millstadt, IL 62260
millstadtems@gmail.com

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·Millstadt, Illinois