2. 

4. Ride-along with the Dayton Fire Department to observe daily operations, enhance your understanding of emergency response procedures, and strengthen partnerships that support community outreach. This experience will allow you to gain firsthand insight into the department’s service delivery, training, and community interaction.

6. I am filling out this form to:*

   1. Schedule a Ride Time
   2. Cancel a Ride Time
8. First Name*
9. Last Name*
11. Phone Number*
12. Email*
14. What organization (school) are you affiliated with?*
    -- Select One --Clark State Community CollegeEdison Community CollegeSinclair Community CollegeButler TechMiami Valley HospitalGrandview HospitalOhio UniversityWright State UniversityCincinnati StateWarren County Career CenterOther
16. If you selected other above, please specify the organization here.*
18. What is the reason for the request (clinicals, job shadowing)?*
    -- Select One --EMTParamedicNurseResidentJob ShadowingFire RecruitOther
20. If you selected other above, please specify your reason here.*
22. What date would you like to ride the medic?*
    What date would you like to ride the medic?
23. What time would you like to ride the medic?*

    1. 0700-1500
    2. 1500-2300
    3. Both time slots
25. Please be mindful of submitting requests on Fridays and during the weekend as Training Center Staff works Monday through Friday, 0700 - 1500.
27. Please select a medic. If you do not have a preference, please select "other," and you will be placed accordingly.*

    1. Medic 2
    2. Medic 11 (Available Tuesday, Thursday, and Saturday)
    3. Medic 13 (Available Tuesday, Thursday, and Saturday)
    4. Medic 14 (Available Tuesday, Thursday, and Saturday)
    5. Medic 15
    6. Medic 16
    7. Medic 18
    8. Fire Apparatus
    9. Other (use this if this is not a clinical requirement)

    Medic availability is filled upon a first come, first serve basis. Your selection does not guarantee your desired selection. You will receive a confirmation email with the medic that you are assigned to.

29. If you selected other above, please specify.*
31. Did you complete the Visitor's Identification and Release Form?*

    1. Yes
    2. No

    Your program coordinator should have provided you with this form, which is listed below. Clinicals and ride-alongs WILL NOT be scheduled until the form is received. 

    You can download this form here. Please complete it and send to Chantel.Wagner@daytonohio.gov prior to requesting a Ride Along.

Leave This Blank:


33. 1. Receive an email copy of this form.
34. Email address

    This field is not part of the form submission.

35. Submit

* indicates a required field