Form Center

By signing in or creating an account, some fields will auto-populate with your information.

Community Emergency Response Team (CERT) Application

  1. Please enter your first and last name

  2. Please provide your home address

  3. Enter your City

  4. Enter your Zip Code

  5. Please enter the best phone number to reach you

  6. Please provide a cell number if it is not the same as your daytime number

  7. Please provide an evening phone if it is not the same as the daytime one

  8. Please tell us if you are interested in taking upcoming seasonal classes

  9. Leave This Blank:

  10. This field is not part of the form submission.