Preparing today for tomorrow s emergencies!stepconference.org/pdf/fire_CERT.pdf · Preparing today...
2
Last updated 3/20/2019 GP Riverside City Community Emergency Response Team Preparing today for tomorrow’s emergencies! COURSE REGISTRATION FORM STEM LEAPS FIRE CERT TRAINING APPLICANT INFORMATION PLEASE PRINT NEATLY NAME LAST FIRST M.I. ADDRESS CITY ZIP DATE SUBMITTED: HOME PHONE : CELL PHONE : STUDENT E-MAIL: PARENT E-MAIL: SCHOOL ATTENDING: Birth date Month Day Year PARENT/ LEGAL GUARDIAN PRINT NAME PARENT/ LEGAL GUARDIAN SIGNATURE: (REQUIRED) COURSE INFORMATION √ SESSION COURSE TYPE LOCATION DATES AND TIMES STEM LEAPS FIRE CERT JULY 2019 CLASS FEMA CERT Basic COURSE Riverside City Emergency Operations Center 3085 St. Lawrence St, Riverside, CA 92504 TUESDAY JULY 9 - 8:00 AM TO 5:00 PM WEDNESDAY JULY 10 - 8:00 AM TO 5:00 PM ** MUST ATTEND BOTH DAYS TO COMPLETE TRAINING CERTIFICATION Class Schedule Subject To Change Without Notice Do you require special accommodations for a disability? If so, please describe accommodations requested below: RETURN COMPLETED FORMS TO: GINA PEREZ- PUBLIC EDUCATION COORDINATOR at: [email protected] City of Riverside Fire Department 3085 St. Lawrence St, Riverside, CA 92504 PHONE (951) 320-8100 http://riversideca.gov/fire/specialprograms/cert/
Transcript of Preparing today for tomorrow s emergencies!stepconference.org/pdf/fire_CERT.pdf · Preparing today...
Last updated 3/20/2019 GP
Riverside City
Community Emergency Response Team
Preparing today for tomorrow’s emergencies!
COURSE REGISTRATION FORM STEM LEAPS FIRE CERT TRAINING
APPLICANT INFORMATION PLEASE PRINT NEATLY
NAME
LAST FIRST M.I.
ADDRESS
CITY
ZIP DATE SUBMITTED:
HOME PHONE : CELL PHONE :
STUDENT E-MAIL:
PARENT E-MAIL:
SCHOOL ATTENDING:
Birth date
Month Day Year
PARENT/ LEGAL GUARDIAN PRINT NAME PARENT/ LEGAL GUARDIAN SIGNATURE: (REQUIRED)
COURSE INFORMATION
√ SESSION COURSE TYPE LOCATION DATES AND TIMES
STEM LEAPS FIRE CERT JULY 2019
CLASS
FEMA CERT Basic
COURSE
Riverside City Emergency Operations
Center 3085 St.
Lawrence St, Riverside, CA
92504
TUESDAY JULY 9 - 8:00 AM TO 5:00 PM
WEDNESDAY JULY 10 - 8:00 AM TO 5:00 PM
** MUST ATTEND BOTH DAYS TO
COMPLETE TRAINING CERTIFICATION
Class Schedule Subject To Change Without Notice Do you require special accommodations for a disability? If so, please describe accommodations requested below:
RETURN COMPLETED FORMS TO: GINA PEREZ- PUBLIC EDUCATION COORDINATOR at: [email protected]
City of Riverside Fire Department 3085 St. Lawrence St, Riverside, CA 92504
PHONE (951) 320-8100 http://riversideca.gov/fire/specialprograms/cert/
CERT MOTTO: “DOING THE GREATEST GOOD FOR THE GREATEST NUMBER OF PEOPLE”
Riverside Fire Department Office of Emergency Management
FEMA – CERT Online registration at:
www.riversideca.gov/readyriverside/cert/
3085 St. Lawrence St, Riverside, CA 92504 Info call (951) 320-8100
Email: [email protected]
STUDENTS UNDER 18 YRS OLD- MUST HAVE PARENT/ LEGAL GUARDIAN SIGNATURE TO ATTEND
