PGFD VRS REGISTRATION
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. You will be emailed a confirmation at the email address(es) provided AT THE CLOSE OF REGISTRATION, NO SOONER!!!. PLEASE READ AND FOLLOW THE DIRECTIONS!!!
Last name of recruit
First name of recruit
"John" or "Jane"
828-West Lanham Hills
849-Laurel Rescue Squad
856/857-PG Water Rescue
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"
Date of entry to your PGFD Station, "N/A" is NOT an acceptable response!
Date of Birth
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.
January 2018 (15,16,19) CPR If needed 17th (Registration closes 1/8/18 @00:00)
February 2018 (19,20,23) CPR If needed 21st (Registration closes 2/12/18 @00:00)
March 2018 (19,20,23) CPR If needed 21st (Registration closes 3/12/18 @00:00)
April 2018 (23,24,27) CPR If needed 25th (Registration closes 4/16/18 @00:00)
May 2018 (21,22,25) CPR If needed 23rd (Registration closes 5/14/18 @00:00)
June 2018 (18,19,22) CPR If needed 20th (Registration closes 6/11/18 @00:00)
July 2018 (16,17,20) CPR If needed 18th (Registration closes 6/9/18 @00:00)
August 2018 (20,21,24) CPR If needed 22nd (Registration closes 8/13/18 @00:00)
September 2018 (17,18,21) CPR If needed 19th (Registration closes 9/10/18 @00:00)
October 2018 (15,16,19) CPR If needed 17th (Registration closes 10/8/18 @00:00)
November 2018 (12,13,16) CPR If needed 14th (Registration closes 11/5/18 @00:00)
December 2018 (10,11,14) CPR If needed 12th (Registration closes 12/5/18 @00:00)
Recruits EMAIL Address
Recruits best phone number for contact
Person completing this forms EMAIL address if different from recruit:
Name and Rank of person completing this form if different from recruit:
Deputy Fire Chief John Doe
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
NO, I have not
YES, I have given the original paperwork to Fire Chief / Commissioner Kuenzli for approval
YES, I have emailed electronic copies to
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"
YES, I need to re-take the ENTIRE PROGRAM
YES, I need to re-take the TEST ONLY
NO, this is my first time taking the VRS program and exam
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. Furthermore, I understand that I will not receive a confirmation letter until after registration for the selected session closes.
Page 1 of 1
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service