Junior Membership Application

To: Parents & Guardians
Please read the copy of the Rules, Regulations, and Procedures for Junior Membership before signing this form. Your signature indicates consent for your child to join the Junior Members of the Upper Frankford Twp. Fire Co. of Bloserville. In order for your child to be a Junior Member, the State Child Labor Law requires him/her to have a Work Permit issued by the school. If your son/daughter is failing any subjects in school, we ask that you please do NOT allow him/her on Fire Company premises during the school week.
Name*
First Middle Last
Address*
Street Address Address Line 2 City State ZIP Code
Email*
Enter Email Confirm Email
Home Phone
Cell Phone
Consent
I hereby give permission for the applicant below to become a Junior Member of the Upper Frankford Twp. Volunteer Fire Company of Bloserville.
Parent or Guardian Signature*
To: Applicant
I agree to become a Junior Member of the Upper Frankford Twp. Volunteer Fire Company and hereby agree to obey all the Rules, Regulations and Procedures of the Fire Company. I will try to the best of my ability to learn and train to be a good firefighter. I have read the Junior Membership Rules, Regulations and Procedures and understand them.
Applicant Name*
First Middle Last
Applicant Phone
Applicant Email
Enter Email Confirm Email
Age*
Date of Birth*
MM slash DD slash YYYY
Gender*
- Male
- Female
Applicant Signature*