Deer Grove EMS - Volunteer App

DEER GROVE EMERGENCY MEDICAL SERVICE

Serving the Villages and Townships of Cottage Grove and Deerfield, and portions of the Town of Pleasant Springs in Dane County, Wisconsin

Volunteer Application

October 13, 2024

Are you looking for a new opportunity, thinking about giving back to the community, or looking for high quality training with opportunities to grow? Whether you are already a licensed medical professional (EMT, PA, RN, etc.) or not medically trained but interested in helping out, Deer Grove EMS needs you!

Deer Grove EMS can offer you the ability to volunteer at any level of EMS care (EMT through Paramedic) with the use of high quality equipment, training with opportunity to advance, uniforms, stipend, and social events with great people to know and learn from.

Before filling out the application below, please read our volunteer information sheet, located here - volinfo.pdf

Personal Information
First Name:
Last Name:
Street Address:
City:
Zip Code:
Home Phone Number:
Cell Phone Number:
Email Address:
Are you at least 18 years old?

EMS Information
Level of Licensure:
WI EMT License Number:
CPR/CCR Trained:
CPR/CCR Expiration Date:
CEVO/EVOC Certification:
CEVO/EVOC Expiration Date:

Additional Information
Do you live in our district:
Do you work in our district:
Do you have a valid WI DL:
How did you hear about us:
Why would you like to be a volunteer with DGEMS:
I read and understand the volunteer guidelines posted above