Paramedic Class Registration

Class Registration - Paramedic

To register for an upcoming Paramedic Course, please complete the form below and submit! Please call 830-581-0384 with any questions you have!
Student Name

First NameMiddle NameLast Name
Current NREMT #
Birth Date

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Student E-mail
example@example.com
Mobile Number
SS# (for criminal background check)
DL / ID #
Issuing State
Expiration Date:
Have you ever been convicted of a Felony, Class A, or Class B Misdemeanor?
If you advised you have a conviction, please explain.
Do you have a high school diploma or GED?
Name of High School/College graduated from:
What size polo shirt do you wear (men's sizes)?
Submit a minimum of 300 words explaining why you want to be an Paramedic.
How will you be paying?
If you selected that your department will be sponsoring you, are they aware of this?
Please provide what Department your with, your Chief's Name, contact phone #, and email address where to send the invoice
What size polo shirt fits you (men's polo)?
Additional Comments
Upload your current immunizations, BLS card, ACLS/PALS card, Driver's license, and a photo for your ID badge.*

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Class Registration - Paramedic