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Instructions

Use this form to apply to EMS courses.

If you have questions, please contact EMS at (203) 452-5146 or ems@trumbull-ct.gov. Please note administrative office is open Monday to Friday during business hours.
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For some classes, Trumbull EMS may offer a discount to active members of other volunteer emergency services. If you are affiliated with a Police, Fire or EMS agency, please complete this section.
Title or Rank
Name of Organization
Address
City
State
Zip Code
Phone Number
As an officer of the above-mentioned agency, I certify that the applicant is an active member and in good standing with our service.
Verify*
1. Yes
2. Not Applicable
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I certify that the statements made herein are true and complete, that I understand the responsibilities of the program, and that no claim will be made by me or on my behalf against the EMS Instructor in charge of this program, their agents or employees, the Trumbull Emergency Medical Service or the Town of Trumbull for any loss, injury or damage which may result from my participation.
Parent or Legal Guardian
If the applicant is under 18 years old, a Parent or Legal Guardian must verify this certification and approve participation.
Parent or Legal Guardian's First Name
Parent or Legal Guardian's Last Name
Verify*
1. Yes

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