BERGEN COUNTY EMS TRAINING CENTER

National EMS Education Standard

East 281 Pascack Road, Paramus, N.J. 07652 201-343-3407 http://www.BergenEMS.org

EMT Courses

Tuesday, Wednesday and Thursday - Days

Meeting Times: Start Date: 9:45 a.m. - 1:30 p.m. plus weekends, see below. Tuesday, August 30, 2011

Tuesday, Wednesday and Thursday - Nights

Meeting Times: Start Date: 6:45 p.m. - 10:30 p.m. plus weekends, see below. Tuesday, August 30, 2011 Weekend Dates (7): Students must attend either Saturday or Sunday The weekend classes are 8:00 a.m. - 4:00 p.m. on:
09/10 or 09/11/11, 09/24 or 09/25/11, 10/15 or 10/16/11, 11/12 or 11/13/11, 12/03 or 12/04/11, 01/07 or 01/08/12 & 01/21 or 01/22/12.

Minimum age: 16 years of age at start of course

The required CPR book is not included, and may be purchased at the EMS Training Center Monday - Thursday for $15.00. The CPR Book is not covered by the Training Fund.

Students with a current Professional-level CPR card must bring it to the first class session.

Completion Date: January 21 or 22, 2012

Bergen County EMS Training Center, East 281 Pascack Road, Paramus, N.J. 07652
$300.00 EMT Starting Tues., August 30, 2011 Tues., Wed. & Thurs. Days 9:45 a.m. - 1:30 p.m. $25.00 Per Semester Out of County Fee. Paid once for all courses taken between 7/1/2011 and 12/31/2011. $300.00 EMT Starting Tues., August 30, 2011 Tues., Wed. & Thurs. Nights 6:45 p.m. - 10:30 p.m. Signed EMT Training Fund Certificate of Eligibility attached. See Course Fee statement below.

MAIL ONLY THIS SECTION TO

Pre-registration Required

NJ State 6 Digit ID #:

Tuition: Does not include the EMT Textbook, which can be purchased at the EMS Training Center at the beginning of the course. Course Fee: No Tuition or Out of County fees for members or prospective members of Volunteer First Aid Squads who submit a signed
EMT Training Fund Certificate of Eligibility with this application. Otherwise enclose indicated tuition and out of county fees.
Last Name Address Zip Code Home Phone ( Date of Birth Your e-mail address Your Signature:
MALE FEMALE

First Town County * ) Business Phone ( Soc. Sec. # Affiliation )

M.I.
Books

EMT Fall 2011

OFFICE USE ONLY

$ $ Tuition Fee

Complete information from you helps us to access adult education funds and to comply with affirmative action reporting regulations. Thank you for checking one of the following: White Black / African-American Hispanic / Latino Asian American Indian / Alaskan Native Native Hawaiian or Pacific

Out of County Fee $ Total Fee Date Paid Cash Voucher Check No. $ Recd By Comp. Check Pers. Check

Note: With this application you are registered. Unless notified to the contrary, Make checks payable to Bergen County Technical Schools.
please report to your first scheduled class. Refunds must be requested in writing within 2 weeks after the start of the class. NO refunds will be given to students who have attended 1 or more class sessions.

rev 05/12/201ke