Bartow County CERT Registration
This is the quick registration form for Bartow County Community Emergency Response Team (CERT). This is only to register for classes. After completion of this form, we will contact you about upcoming classes. Once you are approved for a class, you will receive a link to complete the online application. Please be sure to check your email (including Junk/spam folders) after you submit this form. You should receive a confirmation email almost immediately. Be sure to add bartowcountycert@gmail.com to your approved contacts or you may miss important information.
Email address *
First Name *
Your answer
Last Name *
Your answer
Phone (Best number to call) *
Please do not include dashes or parentheses! Example 7701112222
Your answer
If the number provided is a Cell Phone, is it okay to send text updates? *
Text rates from you carrier may apply.
Street Address *
Your answer
City *
Your answer
State *
Your answer
Are you 18 years old or Older? *
Those under 18 will need a parental consent signed before the last class. Under 16 will be a case by case basis
Required
Gender *
How did you you hear about CERT?
Are you interested in the next class schedule (see below) *
October 15, 17, 22 and 24 from 6:00 PM until 10:00 PM. Simulation drill on Nov 2. All Classes are required for completion.
Criminal History/Background Check *
As a part of a governmental volunteer program, it is required that each member of CERT have a criminal history background check completed by the Bartow County government.
Thank you!
Please check your email including Junk/Spam folders for an email of your response which will act as confirmation of your submission.


A copy of your responses will be emailed to the address you provided.
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