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CERT Training Application

Date of birth (People ages 16-18 must take the class with a parent or guardian)


Full Address

Do you require interpretive services?

Do you require any accommodations?

Assumption of Risk/Exculpatory Clause: For and in consideration of the opportunity offered to me to participate in the above-named activity/activities offered by the City of Auburn Office of Emergency Management, I, as evidenced by my signature below, do hereby hold harmless, release, and waive all claims I may have against the City of Auburn, its officials, employees, agents, or contracted instructors, or any other person(s) involved in this activity for any and all injuries, losses, or damages suffered by myself as result of my participation in this activity/activities. I accept full responsibility for the cost of treatment for any injury, losses, damages, or death suffered by myself while taking part in this activity/activities. I give permission to have my photograph taken during classes and used for publicity purposes by the City of Auburn.

Signature of Applicant (or Parent/Guardian if applicant is under 18 years old)

Choose how to sign