Applications are open for the 2020 Spring Basic Training Class

Keller CERT Application

Keller Community Emergency Response Team (CERT) Application

Please enter all information exactly as it appears on your government-issued ID.

Individual Prefix

First Name *

Middle Name

Last Name *

Individual Suffix

Street Address (Home) *

Supplemental Address 1 (Home)

City (Home) *

State (Home) *

Postal Code (Home) *

Phone-Phone (Home)

Phone-Mobile (Main)

Email (Primary) *

Birth Date *

Alternate Contact Name

Alternate Contact Phone

Driver License Number *

Driver License State *

Shirt Size

I understand by submitting this form that the information above will be verified and a background check completed by Keller Fire-Rescue and/or the Keller Police Department for the purposes of checking my criminal history record so that I MAY be selected to participate in the Keller Community Emergency Response Team (CERT) program.

I also understand my criminal history background MAY disqualify me from being selected to participate in the CERT program. By submitting this form, I give my consent to Keller Fire-Rescue and/or the Keller Police Department to check my criminal history record for the purpose of being selected to attend the CERT program. This information will remain confidential and will not be used for any other purposes.

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Thank you for your interest in the Keller CERT Association. Our next training class is planned for spring 2020. Please see the schedule on the website.

Preparation, Education, Service

Preparation, Education, Service

Keller CERT Training Class Application

Keller CERT Application