Community Emergency Response Team (CERT) Refresher Registration Form
Name
First Name
Last Name
Email Address
example@example.com
Gender
Male
Female
Age Range
18-30
31-40
41-50
50 plus
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
WhatsApp Number (If Different)
Please enter a valid phone number.
Format: (000) 000-0000.
What Parish do you reside in?
*
St. Paul
St. Thomas
St. James
St. Georges
St. John
What are Your Special Skills?
Fire fighting
Welding
Search and Rescue
Sign Language
Bilingual or more
Psychosocial Support
Electrical/Data
Mason
Carpenter
Computer Technology
Other
Please Specify Special Skills Listed as Other Above
Emergency Contact
First Name
Last Name
Emergency Contact Number
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: