VEMS Membership Application

Vernon Emergency Medical Services — Membership Application

Fields marked with * are required. Please complete all sections accurately.

Membership Demographics
Please choose a membership category.
Full name is required.
Date of birth is required.
Please enter a valid phone number.
Valid email is required.
Street address is required.
City is required.
State (2-letter) is required.
Postal code is required.
Employment Information
Military Service
General Questionnaire

Select all true statements:

Weekday Availability

Please select all days you're able to volunteer. This helps match you to a station/crew.

Please select at least one available weekday.
Volunteer Commitment Acknowledgment

By applying, you agree to the commitment of volunteering. Volunteers are required to complete 12 hours of service per week, including a 24‑hour rotating weekend shift, as outlined in our agency's Standard Operating Procedures.

Note: Cadets are not required to ride a 12‑hour shift on school nights, as VEMS strictly adheres to NJ Child Labor Laws. However, on non‑school nights, cadets may ride a 12‑hour shift with a signed permission form from a parent or guardian, as outlined in the Cadet SOPs.

You must acknowledge the commitment to proceed.
Committee Interest

Select all committees you’d be interested in joining:

Applicant Verification
Your typed signature is required.
0 + 0 = ?
Captcha incorrect. Please try again.