Katonah Bedford Hills Volunteer Ambulance Corps

Volunteers in Spirit - Professionals in Service

Volunteer Application

Click to Download the PDF Form

    Step 1: General Info



    Date of Birth*


    City, State Zip*

    Home Phone*

    Work Phone

    Cell Phone

    Cell Phone Carrier


    TShirt Size

    Where did you hear about us?

    Driver's License ID # *

    Name of Employer

    Address of Employer

    Step 2: Previous Affiliations

    Agency Name/Address

    Contact Name

    Contact Telephone Number

    Step 3: Availability

    The Corps asks that you're available to respond for six hours
    a week, either day or night; when would you be able to


    If you are unable to respond to the Corps within the required
    5 minutes, would you be willing to stay at our headquarters
    or within close proximity to the Corps during your


    Please explain why you would like to be a member of the

    Step 4: References

    Please list the names, addresses and telephone numbers of
    three non-family character references:

    Reference 1*

    Reference 2*

    Reference 3*

    Step 5: Driving Info

    Have you ever taken a Defensive Driving course?*


    If Yes, agency/organization where you took your course and
    the date

    Has your license ever been suspended or revoked?*


    If Yes, explain

    Permission for arrest check: *

    Permission to authorize drivers license checks: *

    Please list any accidents over the past 36 months. Note: All
    driving records will be verified through insurance companies.

    Have you ever been convicted of a felony?*


    If so, date of offense



    Contact Us

    In an emergency, dial 911.
    Non-emergency: 914.232.5872
    [email protected]

    Professional media inquiries: 914.815.8280


    Mailing address:
    Post Office Box 43
    Katonah, NY 10536

    Physical location:
    160 Bedford Road
    Katonah, NY 10536