Membership Application

Yardley-Makefield Fire Co. Application for Membership

On behalf of the Officers and Members of the Yardley-Makefield Fire Co., thank you for expressing an interest in joining our organization. If you have any issues, feel free to call us with your questions. We will be happy to assist you.

    Part I: Personal Information

    Your Name (required)

    Your Email (required)

    Your Address (required)

    Home Phone (required)

    Work Phone

    Cell Phone

    Date of Birth (required)

    Driver's License (required)

    Date of Application (required)

    Applying for
    Sr. Membership (18+ yrs old)

    Position Applying for
    FirefighterFire Police

    Years Lived in Area

    Previous Fire / Emergency Services Experience
    (No Experience Necessary—Free Training Provided)

    Employment History

    Education History

    Part II: Emergency Data Information

    Preferred Hospital

    Physician

    Physician's Phone #

    Medical Conditions or Limitations that may prevent you from completing the duties of a firefighter or Fire Police. ( If applicable, medical clearance is required)

    Known Allergies (Include Allergies to Medications)

    Do You Have Asthma
    YesNo

    Do You Wear Corrective Lenses
    NoContactsGlassesBoth

    Part III: Emergency Contact Information

    In case of emergency, please contact the following people:

    First Choice

    Name

    Relation

    Phone #

    Alt. #

    Second Choice

    Name

    Relation

    Phone #

    Alt. #

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