Membership Application
Lakeside Volunteer Rescue Squad
2007 Timberlake Avenue
Richmond, VA 23228
Business (804) 266-7498

Lakeside Volunteer Rescue Squad is continually searching for compassionate and diverse individuals for
membership with our agency. If you have the drive and desire to help and to serve your community in
need, we invite you to fill out an application. Our agency welcomes trained and novice members.

We are a 9-1-1 based volunteer organization that provides basic and advanced emergency medical treatment for the citizens of Henrico County. The community depends on us daily to respond in their time of need. The responsibility is a great one, and takes time, skill, desire, and dedication to perform under adverse and stressful situations in the field.

We would like to thank you for your interest in membership with Lakeside Volunteer Rescue Squad, and we look forward to hopefully meeting you in the near future!

Full Name: *
Your answer
Mailing Address *
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Contact e-mail (Primary point of contact) *
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Contact Phone Number *
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When is the best time to contact you? *
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Are you over the age of 18? *
Date of Birth *
In the event of an emergency, whom should we notify? Include name, relationship and contact information. *
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Have you ever applied for membership with Lakeside Volunteer Rescue Squad? *
If the answer to the above question was yes, what was the outcome of the application and if it resulted in you becoming a member, under what circumstances did you leave?
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What type of Membership are you applying for? *
In a short summary, please explain why you chose to apply for membership with Lakeside Volunteer Rescue Squad. *
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How did you hear about LVRS?
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