50 S Main, West Hartford, CT, 06107, US
Please Enter Full Name
Date of Birth
Emergency Contact Name
Typically, what day(s) of the week would you be most likely to serve?
On the above days, I am typically available
In consideration for the opportunity to participate in the Town of West Hartford’s Community Emergency Response Team (CERT), I
do hereby agree to the terms listed below:
I have carefully read this agreement and understand that this is a contract between myself and the Town of West Hartford. My signature indicates that I have read this release in its entirety, understand all of its terms and have had any questions regarding this release, or its effect, satisfactorily answered.