 |  |  |  |  |  |
Junior Membership Application
PLEASE PRINT NEATLY
DATE:_____________
NAME:_____________________________________________________________________
ADDRESS:_________________________________________________________________
______________________________________________________________
PHONE NUMBER:________________________ DATE OF BIRTH:____________________
PRESENT GRADE IN SCHOOL:____________ MALE/FEMALE:_____________________
EMAIL ADDRESS: ______________________________________________________
In case of emergency, contact the following: (If you need more room, use the back of this sheet)
Name: __________________________________________ Relationship: _______________
Phone: __________________________________________
Allergies/Special Needs:________________________________________________________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
I,___________________________________, wish to become a member of the Goshen Volunteer
(print your name)
Ambulance Corps as a Junior Member. I am willing to attend the required meetings and
abide the Corps By-laws .
SIGNED: ______________________________________________ DATE:_________________
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
PARENTS:
The Junior Members of GOVAC will consist of youth between the ages of 10 - 16
and/or in the sixth grade. Junior members will support the Active Riding members, work
together as a team for the betterment of the Corps and community. They will be given the
opportunity to learn first aid and will have advisors from the Active Riding members.
Meetings will be held once a month (unless otherwise advised) on the first Tuesday night
of the month from 6:30pm to 8:30pm at the GOVAC bay on New Street.
I hereby give my permission for my (son /daughter) to join the Goshen
Volunteer Ambulance Corps as a Junior Member.
Parent/Guardian Signature ________________________________________
DATE:_____________
GOVAC Junior Corps
attn: Membership
P.O.Box 695
Goshen, NY 10924
If you have any questions feel free to email us or call (845) 294-9695.
