Post 53 First Aid Application 2019
Please complete this application thoroughly and carefully before submitting it to be considered for Darien EMS - Post 53's 2018 First Aid Program. The Summer Class will run from June 1 to July 6 and the Fall Class will run during September and October (dates TBA). Generally, classes will be held on Tuesdays from 4:30-6:30 (summer) or 6:30-8:30 (fall) and Saturdays from 2-4. Please submit your application by May 15. You will be notified of the decision in late May. If you do not have your own personal email account, we highly recommend you create one as email is our primary means of contact and we prefer to communicate directly with the student. Please be aware that only two absences are allowed. Direct any questions or concerns to post53firstaid@gmail.com.
Email address *
First name: *
Your answer
Last name: *
Your answer
Gender: *
Age: *
Your answer
Date of Birth (mm/dd/yyyy) *
Your answer
Will you be attending DHS in the fall as a 9th grader? *
Parent email: *
Your answer
Telephone contact: *
Your answer
Do you have any siblings, parents, or relatives that are now or have been involved with Post 53? *
If answered "yes" above, please list the names of siblings, parents, or relatives that are now or have been involved with Post 53
Your answer
Which class would you prefer to take? *
Are you unable to participate in one of the classes? *
Please indicate if you have any of the following certifications:
How did you hear about Post 53? (Max 1000 characters) *
Your answer
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