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The Annual Meeting for the White Cross Vol. Fire Dept. Will be held September 3rd, 2026 at 7pm. Click here for more info
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Jr. Firefighter – Membership Application
Please complete the entire application. Incomplete applications will not be considered.
"
*
" indicates required fields
Step
1
of
9
11%
Name
First Name:
Middle Initial:
Last Name:
Address
Address:
Address Line 2:
City:
State:
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District of Columbia
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Tennessee
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Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip:
Email:
*
Phone:
Date of Birth:
*
Social Security #
*
Mobile Phone Carrier:
*
Parent/Guardian
Do you have your parent/guardian's permission to apply to be a Junior Firefighter?
*
Yes
No
Parent/Guardian Name:
First Name:
Last Name:
Parent/Guardian's Address
Address:
Address Line 2:
City:
State:
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Zip:
Parent/Guardian's Phone:
Emergency Contacts
Emergency Contact #1
First Name:
Last Name:
Relation:
Phone:
Emergency Contact #2:
First Name:
Last Name:
Relation:
Phone:
Medical Information
Doctor:
First Name:
Last Name:
Doctor's Phone:
Hospital:
Hospital Phone:
Medical Conditions:
Allergies:
Do you take any medication?
Yes
No
Please list each medication and what condition it is for:
Background Information
A background check will be done as well. A felony
will prevent
anyone from becoming a member.
Have you ever been arrested, ticketed, fined, etc.? (felonies, traffic tickets, misdemeanors, etc.)
*
Yes
No
Please list the date(s) and what the charge(s) was/were:
Additional Information
What interests you the most about becoming involved with the White Cross Fire Department?
*
Please list other activities, in detail, that you are involved in (sports, volunteer work, church, etc):
*
Signatures
Applicant Signature:
Your Name
Your Name
Your Name
Your Name
Today's Date:
Parent/Guardian Signature:
Your Name
Your Name
Your Name
Your Name
Today's Date:
Parental Consent
My son/daughter has my permission to be a Junior Firefighter with the White Cross Volunteer Fire Department. I give my consent to allow them to be a Junior Firefighter and do not hold the White Cross Vol. Fire Department and First Responders responsible for any actions caused by my son/daughter that is not under the direction of an Officer.
Junior Firefighter Signature:
Your Name
Your Name
Your Name
Your Name
Today's Date:
Parent/Guardian Signature:
Your Name
Your Name
Your Name
Your Name
Today's Date:
Contract of Understanding
I and my son/daughter have read ALL of the Junior Firefighter Guidelines and understand the guidelines set up to outline the purpose of the Junior Firefighters. I and my son/daughter understand that Junior Firefighters serve as supporters of the White Cross Vol. Firefighters to learn the basics of firefighting and to prepare to become a full member at the age of 18. I and my son/daughter understand that Junior Firefighters are to follow all instructions from members of the WCVFD and that the general standard of conduct is to act in the manner of a professional. I and my son/daughter understand that he/she is expected to be courteous and respectful of other members (Junior and Regular) and to all citizens as they are representing the White Cross Vol. Fire Department. I and my son/daughter understand there is a “zero tolerance” policy regarding drug and alcohol use. I and my son/daughter understand that by signing this Contract of Understanding we are declaring that any violation of the guidelines is grounds for immediate dismissal. I and my son/daughter understand that any acts that violate the guidelines and that are illegal by state law will be referred to the Orange County Sheriff’s Department.
Junior Firefighter Signature:
Your Name
Your Name
Your Name
Your Name
Today's Date:
Parent/Guardian Signature:
Your Name
Your Name
Your Name
Your Name
Today's Date:
