Fairfax County CERT Role Player Registration Form

CERT Final Exercises Registration

Thank you for volunteering to serve as a role player / victim actor for CERT final exercises. Further details will be provided closer to the date of the event. Note age requirements: 13-15 year olds can sign up with a participating adult and signed parent permission/hold harmless form; 16-17 year olds must have signed parent permission/hold harmless form; 18 year olds and above must sign a hold harmless form. The hold harmless sign will be provided after registration closer to the event date. Please email community@fairfaxcountycert.org if you have any questions.
Full Name*

First NameLast Name
E-mail*
example@example.com
What date are you registering for to serve as a role player / victim actor?

November 8, 2025 - 7:00 am - 11:30 am at Lorton Workhouse, 9719 Workhouse Way, Lorton, VA 22079December 13, 2025 - 7:00 am - 11:30 am at Fairfax County Fire and Rescue Academy, 4600 West Ox Road, Fairfax, VAPlease email me when future opportunities are available
Contact Number*
Please select all that apply to you*

I am not a graduate of CERT Basic TrainingI am a graduate of CERT Basic Training (please identify locality and class number below)I am a member (or parent or leader) of a scout troop
My CERT locality and class number is (e.g. Fairfax County, 145).
Notice: When you register through this form, you give consent to receive emails through MailChimp and/or Jotform.
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CERT Final Exercises Registration