EMA Volunteer Application
If you are interested in volunteering for our EMA office or one of our Rescue teams, please fill out the form below and someone from our office will contact you about volunteer opportunities.
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Date of Birth
-
Month
-
Day
Year
Date
Veteran Status
Driver License #
*
What State is DL issued In?
Have you ever been convicted of a felony or misdemeanor (other than minor traffic violations) or have you been discharged or forced to resign for misconduct or unsatisfactory service from any position?
*
YES
NO
Times/Days Available
*
Are you currently part of any other Emergency Volunteer Organization?
*
YES
NO
If so, which ones?
What Area would you want to be involved in? (Check all that apply)
*
Incident Support Team
Dive Team
Land Search Team
Swift Water Team
Boat Deck Hand/Boat Operator
Other
Certifications/Skills
Do you currently have any equipment that may be valuable to the rescue teams that we could use if needed? (Ex. four wheeler, side by side, etc)
Signature
*
Today's Date
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: