Community Emergency Response Team (CERT) Registration Form

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The purpose of this form is to register your interest in becoming a member of Franklin County CERT

Name *

Phone Number *

Email Address *

After a disaster there will be a range of tasks and services that will be filled by CERT volunteers. Please indicate the tasks you are interested in performing. *

Search and Rescue

Distribute food and other items

Staff the Emergency Operations Center (EOC)

Provide virtual support from home

Other:

Required

During an activation of the EOC all CERT members, when directed by Emergency Management, must activate as quickly as possible to the EOC unless directed elsewhere by Emergency Management staff. Please select the option that best describes your response capabilities. *

Will activate as directed

Cannot activate as directed under some circumstances (explain below)

Other:

If you cannot activate as directed under some circumstances, please explain why.

CERT members must meet certain training requirements as laid out by the Federal Emergency Management Agency. Some of this training must be done in person. Please list the best days and times that you are available for in person training. *

Please provide any additional information that may be useful in matching you to volunteer opportunities.

What skills and abilities do you have that will be useful before, during, and after a disaster?

Thank you for your interest in Franklin County's CERT program. A member of the team will be in touch to let you know when the next CERT Basic Training date is scheduled.

If you have any questions, please contact Ms. Judi Ring at (850) 322-9510

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