St. George Fire Department CERT Training (2 Days), July 9th & 23rd, 2022

St. George Fire, CERT Training Registration

Please answer the following questions to confirm your enrollment to attend. This information will be used for documentation of those participating in the Community Emergency Response Team (CERT) training and for the generation of completion certificates. Registration is subject to approval.

Question Title

* 1. Name (First and Last)

Question Title

* 2. Address

Address

City/Town

State/Province

ZIP/Postal Code

Question Title

* 3. Phone Number

Question Title

* 4. Email Address

Question Title

* 5. Group/Organization Name:

Question Title

* 6. Have you completed a Basic CERT course? Yes or No - and if Yes, enter the location and year completed.

Question Title

* 7. Please provide your age range (for data collection only)

Under 21

Age 21-44

Age 45-65

Age 65+

St. George Fire Department CERT Training (2 Days), July 9th & 23rd, 2022

St. George Fire, CERT Training Registration

Question Title

* 1. Name (First and Last)

Question Title

* 2. Address

Question Title

* 3. Phone Number

Question Title

* 4. Email Address

Question Title

* 5. Group/Organization Name:

Question Title

* 6. Have you completed a Basic CERT course? Yes or No - and if Yes, enter the location and year completed.

Question Title

* 7. Please provide your age range (for data collection only)

Question Title

* 8. Please provide your parent or guardian's name and phone number if you are a minor:

Question Title

* 9. Do you have any food allergies or dietary restrictions? Explain...

Question Title

* 10. Additional Comments: