Membership Application - Prince Frederick Volunteer Rescue Squad

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Membership Application

Please fill out the department online application. Once completed it will be submitted to the membership committee for review. You will be contacted once reviewed and will be relayed the status of your application. Please ensure the email address provided is accurate as this will be the form of communication with the applicant. It is the applicant’s responsibility to check their email.

Thank you considering becoming a member of the Prince Frederick Volunteer Rescue Squad. We look forward to meeting you and becoming part of our family.

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Applicant Information

Membership Type:

Cadet Member (Age 14-15)
Junior Member (Age 16-17)
Regular Member (Age 18+)
Associate Member
Returning Member
Transfer from another Calvert County Dept

Last Name:

First Name:

Middle Name:

Mailing Address:

City:

Zip Code:

Date of Birth:

Phone Number:

Email Address:

Work/School Information

Occupation:

Place of Employment:

Name of School (If applicable):

Medical Information

Medical Conditions:

Emergency Contact and Relationship:

Emergency Contact Phone Number:

Physician:

Physician Phone Number:

Emergency Response Experience

Emergency Experience:

Training Obtained:

Certifications:

Criminal Information

Criminal Info.:

References

Applicant References:

Application Certification

Application Signature:

Parent or Guardian Signature:

Submission Date:

09/16/2024 1604

Please read Carefully

By submitting this application for membership in the Prince Frederick Volunteer Rescue Squad (PFVRS), I authorize investigation of all statements contained therein. I hereby authorize PFVRS to make any contacts considered necessary for me to become a member, such as current employers, criminal records, etc. It is understood and agreed that any misrepresentation by me in this application, will be sufficient cause for cancellation of the application or for separation from PFVRS as a member at any time. I understand that this application is the property of Prince Frederick Volunteer Rescue Squad and will become part of my personnel file if I am accepted as a member.

POLICY STATEMENT: PFVRS is an equal opportunity organization and shall not discriminate against any member or applicant due to age, sex, marital status, national origin, religion, race, physical or mental handicap unrelated to the performance of the job or any other prohibited reasons. The Membership Committee will review this application and additional information developed during background checks. Applicants may be disqualified for criminal conduct. If applicant is less than 18 years of age, a parent or legal guardian MUST submit this application.

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www.FirehouseSolutions.com	Prince Frederick VRS 755 Solomons Island Road S. P.O. Box 346 Prince Frederick, MD 20678	Emergency Dial 911 Non-Emergency: 443-432-3004 Station Fax: 410-535-5750 E-mail: info@pfvrs.org