Please complete this form for registration. Do NOT submit your information more than one time. All entries must be received by the Monday before the class at midnight. NO LATE ENTRIES WILL BE ACCEPTED. PLEASE READ AND FOLLOW THE DIRECTIONS!!!
Last name of recruit *
Your answer
First name of recruit *
"John" or "Jane"
Your answer
Station assignment *
Select one
PGFD ID Number. N/A is not an acceptable response. You must have completed AND passed a county physical to be issued a number so you can attend VRS class. *
This is a 5 digit number issued by the fire commission, typically beginning with a "2"
Your answer
Date of entry to your PGFD Station, "N/A" is NOT an acceptable response! *
Your answer
Date of Birth *
Your answer
Current Age *
Select one
Does the recruit have a valid CPR for Health Care Providers Card? *
This may be a ASHI CPR PRO card or AHA CPR for Health Care Providers card. Heartsaver CPR, Lifeguarding or any other types are not sufficient.
Month of class registering for? *
Class dates listed are for the Monday, Tuesday, and Friday Classes. If you require CPR plan on attending Wednesday the week of VRS class. If you are Retesting only, Plan on attending the Friday date only. If you are coming for the equivalency portion of the class (requires pre-approval by fire commission for candidates with previous experience and certification ONLY), plan on attending only the Tuesday class. If you have a current CPR Card meeting the criteria of the above question you will only need to attend the Monday, Tuesday and Friday Classes.
Recruits EMAIL Address *
Your answer
Recruits best phone number for contact *
Your answer
Person completing this forms EMAIL address if different from recruit:
Your answer
Name and Rank of person completing this form if different from recruit:
Deputy Fire Chief John Doe
Your answer
Are you requesting equivalency? *
For candidates with previous certification and experience ONLY (Requires PRE-APPROVAL from the PGFD Fire Commission)
If you answered "YES" to the above question, have you submitted your equivalency package? If you answered "NO", then simply click "NOT APPLICABLE". *
Choose one or explain in the "Other" tab
If you are scheduling to re-take the final exam, or re-take the entire program please check the appropriate box. If neither apply (first time taking VRS program and exam), simply click the tab labeled "NO" *
Select one
By clicking "I agree" below, I understand that the doors to the classroom will be closed and locked promptly at 1900 hours and I will not be allowed late entry, I also understand that if I do not bring copies of my FEMA IS 100 and 700 I will not be permitted to take the class and must re-register and begin the process over. *
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