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CERT Training Registration Form

  1. Select Preferred Class Date
  2. CERT Program Media Release
    “By registering for a CERT Basic Class and becoming a member of the Chesterfield County CERT Program I agree that Chesterfield County and its authorized representatives may record or photograph my participation. I further agree that any such materials may be used, in any form, as part of any future publications, print materials, brochures, or other digital media used to promote Chesterfield County, and further that such use shall be without payment of fees, royalties, special credit or other compensation.”
  3. Check Other Programs With Which You Are Affiliated
    Check all that apply.
  4. Leave This Blank:

  5. This field is not part of the form submission.