*Name:     

*Address: 

*City:             State:  TX     *Zip Code:

*Home Phone:        

 Cell  Phone:           

*Email:   

*Course Date/Time Requested (Select One)  October 2 & 9

*Required 

CERT Class Fee $25 - This fee pays for disposable supplies, fire extinguisher refills, and other costs for conducting the CERT G317 class.    The fee must be paid by the end of the first day of class.  The fee is refundable in case of cancellation up to 48 hours prior to the start of the class.  No refunds for cancellations within 48 hours of the class or no shows.  We accept cash, checks, Visa, MasterCard, and payments through PayPal and NetworkforGood.

• Students may use this link for our online payment system:  RCCC eCart System  Choose CERT Class Fee

• Checks should be made payable to RCCC, and sent to PO Box 1662, Rowlett TX 75030-1662

  For Network for Good

REQUIRED FORMS:  Please complete these forms and bring them with you to your class.  A notary will be available at the class if you are unable to find one before your class date.

1. Background Check Form
2. RCCC Waiver of Liability Form
3. CERT Member Profile

By submitting this form, I agree to participate in the Community Emergency Response Team Training course.  The class is taught using the FEMA curriculum, but does not automatically make you part of an active response team.  Graduates are encouraged to contact their own home area CERT Team for membership requirements.  Graduates who live or work in the Rowlett, Sachse or Fate communities are welcome to join our team after completing an additional orientation session.    

The Rowlett Citizen Corps Council encourages citizens to take preparedness seriously in order to minimize loss of life and property in a disaster. 

If you have any special needs or requests for the course please include them with this form.

Special Needs/Requests: