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Name and address

First Name (required):

Last Name (required):

Middle Name:

Title:

Nickname:

Street 1:

Street 2:

City:

State:

Zip:

Home Phone:
Ok to call me here
Work Phone:
Ok to call me here
Cell Phone:
Ok to call me here
Your Email (required):

Demographic Information

Please provide the information below in order to help us prepare for the upcoming course and assure we have all the needed items.

Salem County CERT is open to all Salem County residents over 18 years old. We do not discriminate and the CERT program has something that everyone can participate in regardless of physical abilities.

Date of Birth:

Availability

Please indicate the days and times you are usually available to volunteer. This would be for routine volunteer opportunities. Everyone would receive a call for emergency activations and response would always depend on your personal availability.

Sunday: MorningAfternoonEvening

Monday: MorningAfternoonEvening

Tuesday: MorningAfternoonEvening

Wednesday: MorningAfternoonEvening

Thursday: MorningAfternoonEvening

Friday: MorningAfternoonEvening

Saturday: MorningAfternoonEvening

Email Preferences

We like to keep volunteers informed of important news, schedules, and volunteer opportunities by email, however will not send you any email you prefer not to receive. Use the checkboxes below to select the kinds of email you would like to receive from us.

What kinds of email would you like to receive?

Special Skills

Please let us know about any previous training or skills you have that you feel would benefit the CERT program.

Volunteer Preferences

Emergency Contact

First name:

Last Name:

Street 1:

Street 2:

City:

State:

Zip:

Home Phone:
Ok to call me here
Work Phone:
Ok to call me here
Cell Phone:
Ok to call me here
Your Email (required):

Relationship:

Terms

My submission of this application attests that I am at least 17 years of age. Applicants 17 Years of age may participant in the training but will not be eligible for actual emergency deployment until they turn 18.

CERT training is open to all Salem County residents. Admission to the Salem County Team after completion of the training is subject to approval of the Team Management upon submission of all appropriate documentation. I also understand that my application and completion of the training class does not require me to join the Salem County Team.

I agree

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