Wayne Township Memorial First Aid Squad

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Join the Wayne Township Memorial
First Aid Squad

Please fill out the form below and a membership committee member will contact you shortly. We will provide you all the information and schedules for obtaining CPR and EMT training in the area.

Visit our Frequently Asked Questions Page which has answers some of the basic questions.

First Name:
Last Name:
Address:
City: State: Zip Code:
Date of Birth : (mm/dd/ccyy format)
Home or Cell Phone Telephone:
E-Mail:
Occupation: Employer/School:
Scheduling Preference: Day Evening Unknown
Gender: Male Female
Have you previously served on a Volunteer First Aid Squad? Yes No
If you do not live, work or go to school in Wayne, please tell us why you would like to be a volunteer for our community.
Experience, skills, Training and Certifications (EMT, CPR, First Aid, NIMS, ICS, etc) Please list type and expiration date:
What is the best time to reach you to arrange an interview?:
Wayne First Aid adheres to the Americans with Disabilities Act of 1990. Individuals who qualify and require reasonable accommodations for a disability, please check the box below for us to make special arrangements. A description of your disability and diagnostic or evaluative materials provided by an appropriate certified or licensed professional which is dated within 3 years of the date of your request for accommodations will be required. Wayne First Aid reserves the right to determine the reasonability of the request and alternative accommodations. Check the box here to request reasonable accommodations. Only check if you qualify for the Americans with Disabilities Act of 1990.
ALL STATEMENTS OF FACT MADE HEREIN ARE CORRECT TO THE BEST OF MY KNOWLEDGE. IF I AM ACCEPTED AS A MEMBER OF THE WAYNE MEMORIAL FIRST AID SQUAD, I PROMISE TO CONDUCT MYSELF IN ACCORDANCE WITH THE RULES AND PURPOSES OF THE SQUAD AND TO CONDUCT MYSELF IN A PROFESSIONAL MANOR WHEN ENGAGED IN TREATING THE PUBLIC.