Course Pre-Registration
Individual Student Form

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We request all students and class assistants to
pre-register for all Rescue NC courses!!

This is a pre-registration only, it does not confirm your placement into the class.

Rescue 3 International Students: Once your deposit or payment is received for any Rescue 3 classes, you will received an email or phone call confirming receipt of payment and your confirmation.

Please complete the form below to pre-register for the course you would like to attend.

When you are finished, please click the "Submit Registration" button. You will receive an email confirmation of your pre-registration and information how to submit your payment for Rescue 3 International courses.

STUDENT INFORMATION
First Name:  
Last Name:  
E-Mail:  
Agency Type:  
Agency Name:  
Home Phone:  
Cell Phone:  
Address:  
City:  
State/Zip:    

COURSE INFORMATION
Class Date & Location  

Student Status: