C.E.R.T Training Application

C.E.R.T. Training Registration

WARREN COUNTY, OHIO
This program educates and trains people (age 18 & up) in basic emergency response and disaster preparedness skills. You will learn to help yourself, your family and your community when emergencies happen. Skills Taught will include 1. Disaster Preparedness, 2. Emergency Medical Operations Part I and II, 3. Light Search and Rescue, 4. Understanding Disaster Scene Physchology, Communications and Organization, 5. Fire Extinguisher Training 5. Disaster Simulation and Final Exam.

When: 3 Hours/Every Thursday (No charge)
March 7, 14, 21, 26 and Saturday March 30, 2019

Time:: 6-9 p.m.; Saturday: 8 am to 4:30 pm.
Lunch Provided on Saturday

Where: Warren County Board Of Elections Building
520 Justice Dr., Lebanon, Ohio (Lower level)
Name *

First Last
Address *

Street 1

Street 2

City State

Zip Country
Primary Phone *
Alternate Phone
EMAIL *
example@example.com
In Case of Emergency Please Contact *

First Last
Emergency Contact Relationship
Emergency Contact Phone *
Emergency Contact Alternate Phone
Please provide a couple of sentences or so about your background what you would like to gain from this training. Also, ask questions you may have.
How did you learn about this training class?
I declare under penalty of perjury that all statements on this enrollment form are true and complete, to the best of my knowledge. I understand that false, misleading, or incomplete information shall be cause for disqualiﬁcation.
Date of Application *

Month Day Year
mm-dd-yyyy
Applicant Signature
Name
Send this registration electronically, click (Send Registration)

If you are sending this electronically, you can sign the application on the first day of class.

Send this registration by land mail. Click (Print Registration), complete the printed form, and mail to:

Warren County C.E.R.T.

520 Justice Dr.

Lebanon, OHIO 45036

c/o Warren County EMA
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C.E.R.T. Training Registration