Brentwood Legion Ambulance

Brentwood Legion Ambulance

EMT Class Verification
Members Must Fill Out This Form and Submit It To The Time & Attenance Committee To Receive Tour Credit For Attending Their EMT Class. This Form Will ONLY Be Accepted Electronically.

In Order To Receive Credit For The Portion Of Your Tour Missed Because of EMT Class, Your Instructor MUST Sign This To Verify Your Attendance. You Will Have Two (2) Weeks To Submit This Form From The Date of Your Class. NO EXCEPTIONS
Today's Date:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Name:

First NameLast Name
Email:
For Confirmation Form Was Recieved
Date Of Class:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Time In:
Time Out:
Member's Signature:
Instructor's Signature:
Instructor's Name:
Enter the Message As It's Shown:
Should be Empty:

Members Must Fill Out This Form and Submit It To The Time & Attenance Committee To Receive Tour Credit For Attending Their EMT Class. This Form Will ONLY Be Accepted Electronically.