Membership Application Form

Membership Application

To apply for membership please complete all questions.
Name*

First NameLast Name
What type of service with the Department are you interested in?*

FireEMSAdministrative
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Are you a student?*

YesNo
If yes, what school do you attend?
Drivers license Class*
Valid DOT medical card?
E-mail*
example@example.com
Cellular Number*
Format: (000) 000-0000.
Work Number
Format: (000) 000-0000.
Preferred Method of Contact*

TextCallEmailAny form
Date of Birth*

MonthDayYear
If under the age of 18 please include a legal guardian's contact number and name
Current Employment Location
Please list any prior experience in the field. This includes any certifications
Prior experience is not necessary
What times of the day are you most likely able to respond to a call for assistance*

MorningsAfternoonEveningOver nightAny time
If accepted into the membership of The New Fairfield Volunteer Fire Department, while in the performance of your duties serving the town your photo may be taken and used publicly without any further approval.*
Emergency Contact*

First NameLast Name
Emergency Contact Phone number and E-mail*
Date of Signature*

MonthDayYear
Date
Signature*
By pressing "Apply for Membership" you consent to being contacted by a representative of The New Fairfield Volunteer Fire Department. After having an in-person interview with one of the three Companies of The Department, additional information may be requested.
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