Junior Membership Application - Hampstead Volunteer Fire Company

Past Responses
	Fire	EMS
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2022	673	1500
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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:

03/17/2025 1820

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