If you have not completed the Application for Membership please navigate to the Membership link above and complete the Application for your desired position. Firefighter or Auxiliary.

After completing the Application, please follow the instructions for the next sections on this page. All Information is confidential and can only be accessed by approved personnel.

Medical Information and Emergency Contacts

Please complete the form below to provide medical history and emergency contacts. Information will only be used in necessary emergency situations.

Emergency Form

Name

Provide Your Full Legal Name

First Name

Last Name

1) Emergency Contact's Name

Individuals will be contacted in the order listed below

First Name

Last Name

Relationship to you

Emergency Contact's Phone

(###)

###

####

Emergency Contact's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

2) Emergency Contact's Name

First Name

Last Name

Relationship to you

Emergency Contact's Phone

(###)

###

####

Emergency Contact's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

3) Emergency Contact's Name

A third contact is not required but available if desired

First Name

Last Name

Relationship to you

Emergency Contact's Phone

(###)

###

####

Emergency Contact's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Allergies

Medications

Medical History

In the event of an emergency, I give permission for my information to be released to emergency personnel and my emergency contacts may be notified, if necessary.

(electronic signature for permission)

Date of Signature

YYYY

Background Checks

All White Hall Volunteer Fire Department Members undergo a background check to provide criminal history. Please print the following form, fill out all information, and bring it to the next business meeting.

Link: http://kentuckystatepolice.org/wp-content/uploads/2017/12/fars_rev_11_10.pdf