EMR Driver Class Application

Please fill out the following application for the EMR Driver Class.

Student Info:

Emergency Contact Info

Previous Medical Training

Payment Options

Please select and mail payment (checks preferred) in the amount below by February 15th, 2023 to:

Monroe Volunteer Emergency Medical Service 54 Jockey Hollow Road Monroe, CT 06468

  • Class fees do not include the cost of the textbooks.

  • Funds are non-refundable after the start of the program.

  • Students who successfully complete the program and receive State certification and become an active volunteer may be eligible for a refund of the class fee.