|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: _______________
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
Parent/Guardian Signature ________________________________________ DATE:_____________
|Once completed you can email it or send it to
GOVAC Junior Corps
Goshen, NY 10924
If you have any questions feel free to email us or call (845) 294-9695.
|GOSHEN VOLUNTEER AMBULANCE