Student Application

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Course Selection *

All dates are in the MM/DD/YY format.

Full Name *

First

Last

Phone Number *

Email Address *

Date of Birth *

emergency: Signature Waiver

Gender *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

In case of emergency: *

I give full consent to those qualified at TEMSA Emergency Services and National First Responder Training Complex to perform immediate medical attention.

In case of injury: *

I hereby release TEMSA Emergency Services and National First Responder Training Complex, and all their employees from any injury that I may endure on their site through the duration of the course. I agree to not pursue any legal action against TEMSA Emergency Services or National First Responder Training Complex.

Please review our refund policy: *

I understand that due to purchasing of curriculum, supplies and processing fees, course payments are not fully refundable. I will be only entitled to a 90% refund of what I pay if I elect to withdraw from the course at least 15 days prior to the start of the course. If I withdraw from the course 14 days or less to the start of the course I will receive a 0% refund. If a required deposit was made, it will go towards the balance of tuition and will be non-refundable.

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Send us a message or give us a call and we would be happy to answer any questions that you may have.