CERT Training Registration
This application must be filled out truthfully and accurately. All information submitted will be present on the application to be signed before the start of the class.
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First Name *
Last Name *
Email *
Phone *
Address *
Current Occupation *
Are You Retired? *
Special Training
Please list any special training, education, or certifications here.
Organization Memberships
What other groups are you apart of?
Other Volunteer Services
Do you volunteer elsewhere?
Emergency Contact Name *
Emergency Contact Address *
Emergency Contact Email *
Emergency Contact Phone *
Do you have any ADA (Americans With Disabilities Act) Needs?
How did you find out about CERT? *
What motivates you to volunteer? *
Photo Permission *
By selecting yes, you are giving CERT 98328 permission to use photos of your volunteer service for public awareness and educational purposes.
South Pierce Fire & Rescue Support Services Statement
The CERT training provided by South Pierce Fire & Rescue covers basic skills that are important to know in a disaster when emergency services are not available. It is provided to you for the soul purpose of helping you be better prepared in the event of a major disaster. With training and practice, and by working with others who have been through the classes, you will be better able to protect yourself and do the greatest good for the greatest number in the time immediately following a disaster.

NOTICE: All nine classes of the series must be completed in order to receive a certificate of completion! This training does not however, qualify anyone who has been through the classes to respond with, for, or as a volunteer with South Pierce Fire & Rescue without further training and additional paper work, application and background check followed by acceptance into the South Pierce Fire & Rescue Support Services Program. Applications are available at the SPFR District 17 main office located at 5403 340th St. E. Eatonville WA. 98328 Phone: (253) 847-4333
HOLD HARMLESS/RELEASE OF LIABILITY/PERMISSION REQUEST
You will be required to sign a waiver in-person with the following statements before you begin the training. Please review these statements ahead of time to ensure you understand the terms at the time of signing.

I understand that this training will involve active physical participation, which includes potential risk of personal injury and/or personal property damage. I make this request with full knowledge of the possibility of personal injury and/or personal property damage. Furthermore, I have read and understand the program outline that describes all class sections and the associated activities.

I agree to hold harmless any and all representatives of the CERT 98328 program, South Pierce Fire and Rescue, their Agents, and personnel from any and all claims, actions, suits, and/or all injury that I may suffer and which may arise as a result of my participation in the above mentioned classes.

I agree to follow the rules established by the instructors, and exercise reasonable care while participating in the CERT 98328 program.

I understand that if I fail to follow the instructor’s rules, regulations, and guidelines or if I fail to exercise reasonable care, I can be administratively removed from the program.

By executing this release I certify that I have read this release in its entirety and understand all of its terms and have had all of my questions and concerns regarding this release and/or its effect satisfactorily answered.
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Dieses Formular wurde bei South Pierce Fire & Rescue erstellt.