FCEMS Youth Volunteer Application Form

  • FCEMS Youth Volunteer Application Form

  • Format: (000) 000-0000.
  • Do you have a current Virginia EMT-B certification?*
  • Do you have a current AHA HCP CPR?*
  • Do you have a valid Virginia Driver's License?*
  • Birthdate*
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  • Rows

  • Volunteer Release

    I hereby acknowledge that the information given above is accurate and grant permission for my minor to participate in Floyd County EMS youth programs. I agree that participation in programs are on a voluteer basis and do not receive any compensation. I understand that aswering EMS calls have inherent danger despite the safety protocols and precautions exercised by the agency. I agree to hold FCEMS and the County of Floyd harmless in the event of incident or injury.

     

  • Photographic Release

     

    I give permission for my photograph or photographs containing my likeness to be utilized on social media. I also understand and agree that my photograph can be used for future brochures, advertisements, promotions and social media posts.

     

  • Should be Empty: