WPV-CERT Registration and Release Form

Before the start of your first WPV-CERT class or event, we need to have your completed WPV-CERT Registration and Release Form.

Get the form here... 

You can mail or bring the completed form to     WPV-CERT
    808 Portola Rd.
    Portola Valley, California 94028

You can also bring the completed form to the first class or event you attend.

Or you can scan and email it to Classes@WPV-CERT.org.

You are registering for: Incident Support / Firefighter Rehab Training
Date: Monday, Oct 12, 2020    Time: 5:30 - 9:00 pm
Location: Station 19 - 4091 Jefferson Ave, Emerald Hills

Prerequisite: CERT Basic Training
Time, location, and other details are in the flier.
Get the flier here...

To register, just complete the form below.
All information is required, except comments.

First Name:  
Last Name:  
Number Attending: