Membership Application - Prince Frederick Volunteer Rescue Squad
Prince Frederick Volunteer Rescue Squad

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May 21, 2024

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.

Required   Indicates Required Field
Applicant Information
Membership Type: Required 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: Required
First Name: Required
Middle Name:
Mailing Address: Required
City: Required
Zip Code: Required
Date of Birth: Required
Phone Number: Required
Email Address: Required
Work/School Information
Occupation: Required
Place of Employment: Required
Name of School (If applicable): Required
Medical Information
Medical Conditions: Required
Emergency Contact and Relationship: Required
Emergency Contact Phone Number: Required
Physician: Required
Physician Phone Number: Required
Emergency Response Experience
Emergency Experience: Required
Training Obtained: Required
Certifications: Required
Criminal Information
Criminal Info.: Required
Applicant References: Required
Application Certification
Application Signature: Required
Parent or Guardian Signature:
Submission Date: 05/21/2024 0649

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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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
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