CERT Certification Registration

Riverton City is interested in identifying the residents who have been CERT certified. If you are CERT certified, please fill out and submit the form below so we have your contact information on file.

Unless you were recently trained, you may not have been given all the materials needed to complete the questionnaire.

Contact Information

First Name *

Last Name *

Cell Phone Number *

Home Phone (if applicable)

Email Address *

Street Address *

Address Line 2

City *

State *

Zip Code *

Qualifications

Date of CERT Completion

CERT Certificate Upload