* I request and authorize Central Jackson County Fire Protection District on my behalf of the information needed for entry into the Parmedic/EMT Course. I am aware and agree that this information may be shared with the clinical sites that are a required part of this educational program.
* I have reviewed the information presented on this form and I agree that it is correct as stated.
* I have agree to provide all required documentation requested by the program. If not, I understand that I could be asked to surrender my seat in the Paramedic Program.
* I agree to the total tuition due and payment plan for money owed to Central Jackson County Fire Protection District. I understand that failure to pay any installment when due may result in my removal from the program. I understand and agree that after the first day, neither my voluntary withdrawal nor my involuntary removal from the program will release me of my financial obligation to Central Jackson County Fire Protection District.