CERT Miami Beach

The Miami Beach Community Emergency Response Team

CERT Miami Beach - Signup

Site last published: 06/12/08

CERT Miami Beach Sign Up form
Today's Date
First Name*
Middle Name
Last Name*
Email Address*
Date Of Birth*
Address*
County*
City*
State*
Zip Code*
Sex*	Male Female
Race (for background check)*
Home Phone Number*
Cell Phone Number
Group Affiliation/Neighborhood Associations
Occupation
Any special skills or training?
Other Training	CPR Course First Aid Course Are you a Doctor? Are you a Nurse? Are you a DVM? Are you an EMT? Are you a Paramedic?
Are you a licensed radio operator?	Yes No
Prior Military Service	Army Marine Air Force Navy Coast Guard
Languages spoken fluently	English Spanish Creole
Class Selection*	CERT 2009 Class - April 2009 CERT 2009 Refresher Class - June 6th (Prior Graduates Only)
I have given the above information voluntarily, and I certify that all statements and representations are true and correct. I understand that it will be used and disclosed for CERT purposes or to any party with legal and proper interest, and I release the City of Miami Beach CERT Program from any liability whatsoever for supplying such information. I understand that a background check may be conducted, and that a prior felony conviction, or misdemeanor sex conviction will disqualify my application and prevent participation in the CERT Miami Beach program. I understand that I will not be paid for my services as a CERT volunteer and agree to comply with the City of Miami Beach CERT Code of Conduct.