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

The Lakeside Volunteer Rescue Squad is continually searching for compassionate persons 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 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 the Lakeside Volunteer Rescue Squad.

Full Name: *
Your answer
Mailing Address *
Your answer
Contact e-mail *
Your answer
Contact Phone Number *
Your answer
Are you over the age of 18? *
Date of Birth *
MM
/
DD
/
YYYY
In the event of an emergency, whom should we notify? Include name, relationship and contact information. *
Your answer
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?
Your answer
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. *
Your answer
How did you hear about LVRS?
Next
Never submit passwords through Google Forms.
This form was created inside of Lakeside Volunteer Rescue Squad. Report Abuse - Terms of Service - Additional Terms