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 Name
Middle Name
Last Name
Current NREMT #
Birth Date
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
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31
Day
Please select a year
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
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2000
1999
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1950
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1948
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1946
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1943
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1941
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1937
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1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
Year
Address
Street Address
Street Address Line 2
City
State / 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?
Please Select
Yes
No
If you advised you have a conviction, please explain.
Do you have a high school diploma or GED?
Please Select
Yes
No
Name of High School/College graduated from:
What size polo shirt do you wear (men's sizes)?
Please Select
S
M
L
XL
XXL
XXXL
XXXXL
Submit a minimum of 300 words explaining why you want to be an Paramedic.
How will you be paying?
Please Select
Cash
Check
Credit Card
Invoice my department
If you selected that your department will be sponsoring you, are they aware of this?
Please Select
Yes
No
N/A
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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