Junior Membership Application - Hampstead Volunteer Fire Company

Past Responses
	Fire	EMS
2025	639	1483
2024	658	1501
2023	717	1599
2022	673	1500
2021	604	1440
2020	554	1143
2019	537	1208
2018	551	1390
2017	792	1454
2016	719	1397
2015	812	1410
2014	752	1288
2013	608	1251

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Junior Membership Application

Indicates Required Field

Personal Information

Last Name:

First Name:

Middle Name:

Current Address:

City:

State:

Zip Code:

Home Phone:

Cell Phone:

Child's Email Address:

Parent's Email Address:

Parent #1 (or Guardian's) Name:

Parent #2 (or Guardian's) Name:

Emergency Contact Information

In Case of Emergency Contact #1:

Emergency Contact #1 Address:

Emergency Contact #1 City:

Emergency Contact #1 State:

Emergency Contact #1 Phone #:

Emergency Contact #1 Relationship:

Emergency Contact #2 Name:

Emergency Contact #2 Phone #:

Emergency Contact #2 Relationship:

References

Please provide the names of any fire company personnel you are acquainted with (if any):

Education ***Report cards are checked quarterly. The Junior must maintain at least a C average in school.***

Name of School Currently Enrolled:

Name of Counselor / Advisor:

Please upload a copy of your most recent report card:

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General Information (* Optional) NOTE: you must be ages 10 (enrolled in 5th grade) - 15 to apply.

Date of Birth:

Do you have any physical limitations or disabilities which may limit participation in physical activities?:

If Yes, please describe:

Do you have any medical conditions we need to be aware of?:

Please describe:

Why do you want to be a member of the Hampstead Junior Fire Company?:

NOTE: NO APPLICATION WILL BE ACCEPTED WITHOUT THE FIRST YEARS DUES PAID IN FULL!

In order to be considered for membership you must submit a recent photo with your completed application.:

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I certify that all statements are true. I understand that any false statements made will be grounds for rejection or dismissal. I agree to abide by the By-Laws and rules of the Hampstead Volunteer Company

By typing my name I am certifying that all the information is honest and correct.

Signature of Applicant:

Signature of Parent or Guardian (If applicant is under 18):

Date of submission:

02/15/2026 1253

Upon submission of this application you will be directed to our Square page so you may pay the $5.00 application fee.

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www.FirehouseSolutions.com	Hampstead Volunteer Fire Engine & Hose Company No. 1 1341 North Main Street Hampstead, Maryland 21074	Emergency Dial 911 Station 2 Voice: 410-239-4280 Station 2 Activities: 410-374-2424 Station 2 Fax: 410-239-0523 E-mail: info@hampsteadvfd.org