Signup - EMT Original Academy Class

Location: Wilton EMS Station #1 - 1 Harran Lane - Wilton
Start Date: 05-01-2023
Days of the week: Monday through Friday
Time: 08:00 AM - 05:00 AM
NYS Written: 06-15-2023
Tuition Cost: 0
Textbooks: 0 (AAOS eBook)
Prerequisites: Need tablet or laptop for eBook

First Name and M.I.*
Last Name*
Date of Birth*
MM slash DD slash YYYY
Sex*
- M
- F
Check if this application is for:*
- Original Certification
- Recertification
EMS Identification Number*

(if you have one) Only write your NYS EMS number in this space
Are you now or have you ever been certified as an EMS provider?
- Yes
- No
EMT or CFR #*
Cert Level
Certification Expiration Date*
MM slash DD slash YYYY
Do you belong to a recognized NYS EMS response Agency?*
- Yes
- No
Select the NYS EMS response agency you belong to:*
Select the NYS EMS response agency you belong to:*
Other Agency Name:
Secondary EMS Agency:
Other Secondary Agency Name:
Email*
Enter Email Confirm Email
Address*
City*
State*

Please enter 2 character abbreviation
Zip*
County*
Other County*

(Enter your county if it was not listed in the dropdown above)
Primary Phone Number*
Secondary Phone Number
SSN*
Trouble with this form? Don't freak out! Email us at training@saratogaems.org