Enrollment Agreement – Emergency Medical Services University, LLC

California Enrollment Agreement

Esign Disclaimer *

I consent to the use of electronic records, signatures, and document creation as specified above.

Name

First *

Middle Initial *

Last *

Email Address *

Phone Number *

Date right Birth

Address

Address Line 1 *

Address Line 2

City *

State *

Zip Code *

How did you hear about us? *

Social Security Number *

Date of Birth *

General Enrollment Agreement Terms

I hereby waive placement assistance *

T-Shirt Size *

Student Initials *

Signature Date *

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Opening Hours:
Monday – Friday 7am – 7pm PST

Saturday & Sunday 7am – 7pm PST

Phone: (800) 728-0209
Email: info@emsuniversity.com

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Corporate Mailing Address:

501 South 48th Street, Suite 105, Tempe, AZ 85281

Our Locations: 501 South 48th Street, Suite 105, Tempe, AZ 85281 – 4945 East 29th Street, Tucson, AZ 85711 – 1730 SW Military Drive, Suite 202, San Antonio, TX 78217 – 6910 Miramar Road, Suite 206, San Diego, CA 92121 – 32980 Alvarado-Niles Road, Suite 810, Union City, CA 94587 – 1452 Hughes Road, Suite 360, Grapevine, TX 76051

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