DC CERT Team - Registration Form
DC Community Emergency Response Teams(CERT) are groups of dedicated volunteers trained in emergency preparedness and response. CERT Teams build preparedness by organizing their communities before disasters. By joining the DC CERT Team, you will have the opportunity to: 1. Educate yourself, your family, and other about preparing for emergencies. 2. Help your neighbors in times of disasters. 3. Strengthen your relationship with your community.
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Date of Birth
*
-
Month
-
Day
Year
DOB
Mobile Phone Number
*
Mobile Number
Secondary Phone Number
-
Area Code
Phone Number
Are you a CERT Graduate?
*
Yes
No. Tell me more about upcoming class
Yes, but i need a refresher class. Tell me more about upcoming class
No, I just need to complete my skills assessment
Currently taking the class
Select One
Medical Training
*
None
CERT Training Only
Current First Aid/CPR/AED Certificate
Non-current First Aid/CPR/AED Certificate
EMR - Emergency Medical Responder
EMT - Emergency Medical Technician
Paramedic
Nurse or Doctor
Select One
Select the CERT Team to join
*
Ward 1 - CERT Team 1
Ward 2 - CERT Team 2
Ward 3 - CERT Team 3
Ward 4 - CERT Team 4
Ward 5 - CERT Team 5
Ward 6 - CERT Team 6
Ward 7 - CERT Team 7
Ward 8 - CERT Team 8
Select One
IS100 Introduction to Incident Command System
Browse Files
If Available
Cancel
of
IS700 Introduction to the National Incident Management System
Browse Files
If Available
Cancel
of
Any Professional Certificate/License
Browse Files
Not a requirement
Cancel
of
Any Professional Certificate/License
Browse Files
Not a requirement
Cancel
of
Emergency Contact
*
Name
Emergency Contact - Phone Number
*
Emergency Contact - Relationship
*
Relationship
Emergency Contact - Address and any other information you wish to share
*
Address and Telephone #
NOTE: This database is maintained by the DC CERT Program Manager for the purposes of supporting, building, and organizing disaster preparedness in the District of Columbia.
Submit
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