CERT Volunteer Form

CERT Member/POC Information Form

** The information on this form will only be shared with the Team Leadership **
Name*
First Name Last Name
Address*
Cell #*
We need your Cell # so the Team can contact you when we need your assistance.
Email*
example@example.com
Residency*
CERT would highly prefer that all POCs be Full Time residents since hurricane season is when we have the greatest need for POCs in our com
Months Here (If Seasonal)
Oct - Mar, July etc
How would you like to participate on the Team?*

Hurricane Point of Contact (NO Training Required)CERT Volunteer (Training Preferred)
Would you like to attend CERT Training?*

YesNo
Would you attend bi-monthly CERT meetings?*

YesNo
Do you have any of the following: (Check all that apply)

Golf Cart4 Wheel Drive VehicleChain SawPry BarCome-a-longChains and/or ropeTwo-way RadioHam RadioGenerator
Helpful tools you can provide
Special skills/previous training: (Check all that apply)

MedicalFirst AidCPRPoliceRescueFire FighterEMTNurseMilitary
Other Skill/Training
Things willing to participate in: (Check all that apply)

Canvas NeighborhoodWork Phone/Two-way RadioTransportStaff an Emergency CenterHand-out/Collect door-to-doorDocument ActivitiesHelp Form Hurricane TeamsHelp Manage Hurricane TeamRescue TeamCommunicationDrill Preparation
Other
What Zone are you in?
After hitting "Submit" a CERT member will contact you by email.
Should be Empty: