Boles Fire Protection District EMT Program Application

Section 1: Applicant Information

First name

Last name

Date of Birth

Month

Day

Year

Phone

Address

City

State

Zip

Emergency Contact Name

Phone

Section 2: Interest Statement

Why are you interested in becoming an EMT?

Do you wish to have a textbook?

Yes

Shirt Size

Section 3: Documents

Driver's License Front & Back

Health Insurance Front & Back

Vaccination Records (required for clinical participation)

Section 4: Agreement

I certify that the information provided in this application is true and accurate to the best of my knowledge. I understand that submission of this application does not guarantee acceptance into the Boles Fire Protection District EMT Program.

Agreement Selection

I agree to the above statement

BOLES FIRE PROTECTION DISTRICT

Proudly Serving

Gray Summit, Labadie, Villa Ridge, & St. Albans
Since 1971

Boles Fire Protection District EMT Program Application

Contact Boles Fire Protection District