Goshen Volunteer Ambulance Corps

Junior Membership Application

                                                                          PLEASE PRINT NEATLY                                                   

                                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:_________________         


        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:_____________
Once completed you can email it or send it to

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.