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2. ServSafe Course and Proctored Exam Registration
4. Today's Date:*
   Today's Date:
6. First Name*
7. Last Name*
9. Phone Number*
10. Email*
12. Prefered contact method:*
    -- Select One --PhoneEmail
13. I would like to register for:*
    -- Select One --Class instruction and Proctored ExamProctored Exam

    Class instruction is not required to register for a Proctored exam.

17. Please select the date(s) below for your class and/or proctored exam.

    *Class instruction is not required to take the proctored exam.*

19. 2 Day- Class Instruction Date with Exam:
    -- Select One --4/13/26 & 4/14/26 In Person7/6/26 & 7/7/26 In Person10/12/26 & 10/13/26 In Person
20. Proctored Exam Date:*
    -- Select One --2/18/26 (P)3/9/26 (P)4/14/26 (P) 5/1/26 (P)6/18/26 (P)7/7/26 (P)8/4/26 (P)9/15/26 (P)10/13/26 (P)

    P = Proctoring only offered

    I&P = Instruction and Proctoring offered

24. A $75 fee will be required SEVEN DAYS proir to the date of Instruction and/or Proctoring.

    Payments can be made by phone at (252) 636-4936 or by cash and check at the Craven County Health Department.

    **To Confirm that you have registered and signed up for the class or proctored exam, call (252) 636-4936.**

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27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit

* indicates a required field