Community Emergency Response Team (CERT) Training Class Registration Form

The City of Hampton Office of Emergency Management offers free online emergency preparedness training for anyone who lives or works in the city. This training provides general preparedness information and also serves as the foundation for those who are interested in joining the city’s Community Emergency Response Team (CERT). You do not need to be interested in volunteering to take this training.

Below are the topics covered:

Disaster Preparedness
Team Organization
Disaster Medical Operations Part 1
Disaster Medical Operations Part 2
Disaster Psychology
Fire Suppression
Light Search & Rescue
Terrorism
Final Exam

Those who complete all modules and the final exam are then eligible to
participate in an in person, hands on practical exercise, which is required
for those who wish to become CERT volunteers.

To register for the training please fill out the information below, you will
receive a follow up email with further instructions on how to access the
material.

Name:*

First NameLast Name

Email:*

example@example.com

Home Number:

Please enter a valid phone number.Format: (000) 000-0000.

Mobile Number:

Please enter a valid phone number.Format: (000) 000-0000.

Work Number:

Please enter a valid phone number.Format: (000) 000-0000.

Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Neighborhood/Subdivision:

In case of emergency, please notify:

Relationship:

Home Number:

Please enter a valid phone number.Format: (000) 000-0000.

Mobile Number:

Please enter a valid phone number.Format: (000) 000-0000.

YesNo

If yes, what accommodations do you require?:

Personal useCERT Team Member

YesNo