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Program Registration

To enroll in a Trans-Care EMS Education program, prospective students should fill out the registration form provided below. Once we receive your completed form, expect an email within 5 business days to the address you've provided. This email will contain additional details regarding the course you've registered for. 

**PLEASE DO NOT SUBMIT A REGISTRATION FORM IF THERE ARE NO CLASSES LISTED UNDER "COURSE START DATE". YOUR REGISTRATION WILL NOT BE PROCESSED.**

Select Training Course

Course Start Date

Full Name

Street Address

City/State/Zip

Email

Phone Number

Date of Birth

Education

Current High School Student

High School Diploma

GED

College Graduate

Current Licensure/Certification

Not licensed/certified

EMR

EMT

Advanced EMT

Paramedic

RN

Other (e.g., physician, PA, NP, etc.)

Have you ever been CONVICTED of a criminal offense?

Yes

No

If YES explain below

Do you have any criminal charges pending?

Yes

No

Payment Information

Self Pay (Bill Me)

Bill Department/Agency (complete form below)

If billing department/agency please provide contact information

Thank you!

We have received your submission.

Error

Bad respond

Questions about courses can be sent to trainingcenter@trans-care.com . 

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