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2. Schertz EMS Passport to Care

   For a very low annual cost, you and your family can now have peace of mind knowing if you ever have to call 911 for a medical emergency, there could be absolutely no out-of pocket costs for the care and transportation that would be provided by Schertz EMS.

   
   

   As a member with health insurance, any payment received from insurance will be considered as payment in full. This benefit means no out-of-pocket costs for ambulance transportation provided by Schertz EMS.

   
   

   Please fill out the following information if you are interested in becoming a Passport to Care member. Upon completion you will be contacted to complete your membership.  If you prefer to complete the registration process over the phone, please call 210-619-1450 after submitting this renewal.

4. First Name*
5. Last Name*
7. Phone Number*
8. Email Address
10. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
12. Electronic Signature*
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14. 1. Receive an email copy of this form.
15. Email address

    This field is not part of the form submission.

16. Submit

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