CERT Online Enrollment

Thank you for your interest in CERT! 

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Are you a member of a Neighborhood Crime Watch, Homeowner’s Association, or any other organization/club, please indicate the name of the group and its president:
Do you have any physical or medical conditions that might affect your participation in some of the exercises used in this course? If so, please explain:
Year(s)
Please round to the nearest year
Year(s)
Please round to the nearest year
Have you ever served with any branch of the United States Military?
Do you have any disaster related training or experience?
Have you ever received training in any of the below?
Have you ever received training in any of the below?
By completing this form, you agree to submit to a complete criminal background investigation and acknowledge the submittal of your CERT application to the Town of Uxbridge, MA.