EMT Course Application

EMT Course Application

Complete this application using the original wording and structure as closely as possible. Fields default to optional unless marked required in the source.
Applicant Information
Oldham County EMS will host an EMT course beginning September 3, 2026, and ending December 31, 2026.

The class will meet every Thursday from 18:00 - 22:00 hours. The class will be taught in a "flipped classroom" model so, all tests and lectures will be online. The class nights will review any material that the students have questions on and then cover the skills that are required.

The cost of the course is $650.00. A deposit of $150 is required to hold your seat, the balance will be due in monthly payments of $125 once class starts. If the students are hired by Oldham County EMS and complete one year of employment, the course fee will be reimbursed to the student.

The course fee includes all materials needed for the class. The cost of the course does not include the NREMT testing fee of $104.00.

Kentucky requires all applicants to be 18 years old at the time of testing.

If you do not have an AHA BLS certification, we will be offering the class on August 27 at 18:00 at an additional cost of $150.
Full Legal Name

First NameMiddle NameLast Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Street Address
City
State
Zip Code
Primary Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email Address
example@example.com
Education and Driver Information
High School Diploma or GED? (Required by the state for certification)
Driver’s License State
Driver’s License Number
CPR and Background Information
Current CPR Certification? (American Heart Association BLS/Healthcare Provider level)
CPR Certification Expiration Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
If No - Will complete prior to September 3, 2026 or attend class on August 27 at 18:00?
Have you ever been convicted of a felony or a misdemeanor involving violence, theft, or drug offenses?
If Yes - Explanation
Emergency Contact Name

First NameMiddle NameLast Name
Emergency Contact Relationship to Applicant
Emergency Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Pay Your $150 Deposit Here
Should be Empty:

EMT Course Application

Applicant Information

Education and Driver Information

CPR and Background Information