PEEKSKILL COMMUNITY VOLUNTEER AMBULANCE CORPS
Home
About Us
Membership
Application
Adult Corps Application
Contact
Events
Request EMS Coverage
CPR
Donations
Incidents
Photo Gallery
St. Patrick's Day Parade 2022
August 23rd HQ Cleaning
August 14th Duty Crew
August 10th Peekskill Police Department Youth Academy
August 10th Busy day
August 6th Peekskill High School Group Tour
August 6th National Night Out
August 3rd Hudson Valley Exposition
July 27th Peekskill Summer Sounds
July 27th Donation to Members
July 21st Mountain Bike Race
July 21st Italian Feast
July 20th - Italian Feast
July 19th - Italian Feast
July 18th - Italian Feast
July 17th - Italian Feast
Saturday Night Volunteers July 13, 2019
Parade July 4, 2019
Yorktown Structure Fire
June 30, 2019
Emergency Services Trailer Operations and Safety Program June 29, 2019
June 27, 2019
Parade Prep June 26, 2019
Girl Scout Troop 1395 - June 25, 2019
Stop the Bleed - June 24, 2019
Fat Tire Festival - June 9, 2019
Be First Boxing - June 9, 2019
Youth Corps Training - June 8, 2019
American Legion - June 8, 2019
Rig Checks - June 7, 2019
Summer Cleaning - June 4, 2019
Autism Awareness Month
EMS Week 2019
St. Patrick Day Parade
Peekskill River Front
Dinner Dance
Polar Plunge
City Hall Drill- November 1st, 2014
Indian Point Drill
Proclamation from The City of Peekskill
50th Anniversary
Application for Membership
Please provide the requested information below, or you can download the forms,
Youth Application
, fill it out and send it back to us.
Youth Corps
Personal Information
*
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Name
*
First
Last
Address
*
Line 1
Line 2
City
State
Zip Code
Country
Date of Birth (MM/DD/YYYY)
*
Email
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Home Phone
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Cell Phone
*
School or Employer Information
Employer or School Name
*
Address
*
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State
Zip Code
Country
Employer or School Phone Number
*
How long there?
*
1-6 Months
6 Months to 1 Year
1-3 Years
Over 3 years
Parent or Guardian Info
Parent or Guardian's Name
*
First
Last
[object Object]
Parent or Guardian's Phone Number
*
References
1st Reference Name
*
First
Last
1st Reference Address
*
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Line 2
City
State
Zip Code
Country
1st Reference Phone Number
*
1st Reference Email
*
2nd Reference Name
*
First
Last
2nd Reference Address
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Line 1
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City
State
Zip Code
Country
2nd Reference Phone Number
*
2nd Reference Email
*
How did you hear from us?
*
Website
Walk In
Current Member of PCVAC
Facebook Page
Goggle Search
School Rep (Teacher, Guidance counselor, etc.)
If Referred by a Current Member, who?
*
Limitations
Please list any limitations, if any.
*
Background Information
Have you been convicted of a crime, other than traffic violations?
*
Yes
No
Have you ever been a member of PCVAC or any other ambulance agency?
*
Yes
No
If yes, which agency?
*
Have CPR Certification?
*
Yes
No
Please list any others, if any
*
Have First Aid Certification?
*
Yes
No
Please make sure all above information is correct. Some additional information is required, such as parent or guardian permission.
Please hit submit button below and we will contact you shortly. Thank you.
Submit
Home
About Us
Membership
Application
Adult Corps Application
Contact
Events
Request EMS Coverage
CPR
Donations
Incidents
Photo Gallery
St. Patrick's Day Parade 2022
August 23rd HQ Cleaning
August 14th Duty Crew
August 10th Peekskill Police Department Youth Academy
August 10th Busy day
August 6th Peekskill High School Group Tour
August 6th National Night Out
August 3rd Hudson Valley Exposition
July 27th Peekskill Summer Sounds
July 27th Donation to Members
July 21st Mountain Bike Race
July 21st Italian Feast
July 20th - Italian Feast
July 19th - Italian Feast
July 18th - Italian Feast
July 17th - Italian Feast
Saturday Night Volunteers July 13, 2019
Parade July 4, 2019
Yorktown Structure Fire
June 30, 2019
Emergency Services Trailer Operations and Safety Program June 29, 2019
June 27, 2019
Parade Prep June 26, 2019
Girl Scout Troop 1395 - June 25, 2019
Stop the Bleed - June 24, 2019
Fat Tire Festival - June 9, 2019
Be First Boxing - June 9, 2019
Youth Corps Training - June 8, 2019
American Legion - June 8, 2019
Rig Checks - June 7, 2019
Summer Cleaning - June 4, 2019
Autism Awareness Month
EMS Week 2019
St. Patrick Day Parade
Peekskill River Front
Dinner Dance
Polar Plunge
City Hall Drill- November 1st, 2014
Indian Point Drill
Proclamation from The City of Peekskill
50th Anniversary