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Respond Emergency
  Serving Peel Region and Surrounding Area
    Home ---- About-Us ---- Places-to-Go ---- Sponsorship ---- Membership ---- Emergency-Numbers ---- Photo-Gallery ---- First-Aid ---- Contact-Us
                    MEMBERSHIP APPLICATION
  CONFIDENTIAL

Please answer all questions:
 

Surname:       Given Name(s):  
 

Address:    

 

City                Prov.      Postal Code

Contact Information:

  Home #     Work #     Wireless #
  Email          Preferred Contact # 
Personal Information:  (If you prefer, this information can be given in person)
Employer       
Address     
City              Prov.       Postal Code        
  Occupation      If Other, Please enter here  
 
Date of Birth?                                
 
Have you previously Volunteered?          
 
Do you own a vehicle that could be used for Volunteer work?
 Year  Make  Model  Colour License
Describe why you would like to volunteer with Respond Emergency: 
 
Describe any Post-secondary Education:: 
 
Describe your Hobbies and Interests:
 
Describe any Medical Conditions:
 
Describe any other clubs or associations, include your activities therein and dates: 
  (Please Omit religious, political and ethnic groups if you wish)
 
Please indicate if you own or have access to any of the following:
 
 
  Car
  Truck   Camper   Boat
 
  Van   Snowmobile   4WD   ATV
Please indicate any Training Received:
 
 
   Sailing    Traffic Direction    Auto Extrication     First Aid
 
   Scuba    Ground Searching    Radio Comms.     CPR

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Becoming a member of Respond carries with it considerable responsibility.  As a group we require a certain measure of dedication to the organization, the public and the emergency services with whom we serve.  Members are required to provide their own safety equipment and volunteer a minimum of 10 hours per month at events, incidents, and road safety patrols.

 

All information provided in this application will remain private and confidential! 

Your submission of your application shall constitute your intention to join, and provides Respond permission allowing for a criminal records check.

NOTE:  Within three (3) months of signing and dating this application the member must hold a valid Standard First Aid Certificate.

Final acceptance of this application is subject to approval by the executive team upon review of all submissions.