C.E.R.T. -Layton Electronic Services

Community Emergency Response Team (C.E.R.T.)

October Fall Course - 2022 - 437 North Wasatch Drive Registration Ends: Oct 8, 2022
Class Dates: Oct 6, 2022 to TBD
Cost: $25.00

Session One: Oct 06, 06:00 PM - 10:00 PM
Session Two: Oct 08, 09:00 AM - 05:00 PM
Session Three: Oct 15, 09:00 AM - 01:00 PM

Notice: A minimum of 15 students must be registered 2 weeks prior to the class start date or the course may be cancelled. Classes may be subject to change without notice.

After payment, an email will be sent to you containing the link for the online portion of the certification. Please complete prior to 10/6/2022

First Name:

Last Name:

Last 4 digits of Social Security Number

Gender:

Date of Birth:

Home Address:

City You Live In:

Primary Phone:

Alternate Phone:

Email Address:

District:

If you do not know your District or Area, use this map to search your address

Area:

If you do not know your District or Area, use this map to search your address

I, , volunteer to serve as a certified Community Emergency Response Team (CERT) member, in responding, during a disaster or as a certified CERT instructor and/or committee member within the boundaries of Layton City

I verify by my signature below that information I have provided the City is accurate to the best of my knowledge, and I have read each of the items listed Here and agree to be bound by them.

If you are signing this application electronically, you agree that your electronic signature is the legal equivalent of your manual signature. You also agree that no certification or verification is necessary to validate your e-signature.

Volunteer Signature:

Date: