Next Membership Meeting

Wed., September 13
7:00 pm



Find out more
and fill out an application
♦♦♦
Youth Corps
for high school age volunteers

Youth Corps Application

PLEASE NOTE: You must print this application upon completion (completed application will be displayed after submission), have your parents fill in and sign the pertinent portion of the printed application and bring the signed application with you to the interview.

Email Address
You must enter a valid email address
Confirm Email Address
Email Addresses don't match
Name
You must enter your name.
Date of Birth
You must enter your birth date.
Mo: Day: Year:
Street Address
You must enter your street address
City
You must enter your City
State
You must enter your State
Zip Code
You must enter your Zip Code
Phone Numbers
You must enter at least one phone number
Home: Cell:
Reason for Joining
You must enter a reason for joining
Medical/Health Conditions
Y

Emergency Contacts

Emergency Contact 1
You must provide 2 emergency contacts
Phone Numbers
You must provide phone numbers
Relationship
You must enter your relationship to this contact
Emergency Contact 2
You must provide 2 emergency contacts
Phone Numbers
You must provide phone numbers
Relationship
You must enter your relationship to this contact
When would you be able to ride? (check all that apply)
Weekends: Weekdays: Days: Nights:

Training

CPR?
$nbsp;
Yes Expires: Mo: Day: Year:
CFR?
 
Yes Expires: Mo: Day: Year:
First Aid?
 
Yes Expires: Mo: Day: Year:
Do you anticipate joining the NCAC Senior Corps upon your 18th birthday?
Yes No Don't Know
Do you plan to attend college?
Yes No Don't Know
If so, will it be local?
Yes No Don't Know
You must agree to the below provisions in order to submit the forms.
I CONFIRM BY TYPING MY NAME BELOW THAT ALL THE INFORMATION PROVIDED HERE IS TRUE AND CORRECT TO THE BEST OF MY KNOWLEDGE.

I Agree:
Type your Name:
You must type your name
Characters do not match. Try again.

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251 North Midland Avenue Nyack, New York 10960 (845) 358-4824