By submitting this application, I hereby request permission to participate in the Carter County Community Emergency Response Team (CERT) Program and that I am 18 years of age or older. I understand that response and training will involve physical participation, which includes a potential risk of personal injury and/or personal property damage. I make this request with full knowledge of these risks. Further, I have read and understand the Program outline that describes the training and associated activities (a complete description is available at www.citizenscorps.gov/cert/).

I agree to indemnify and hold Carter County, the Carter County CERT,Carter County Emergency Management, and each of their officers, governing bodies, agents, employees, personnel, and volunteers, harmless from any and all claims, actions, or suits for any injury or loss that I may suffer, or which may arise as a result of my participation in the above mentioned program. I understand that personal safety is the foundation of the Carter County CERT and agree to follow the Code of Conduct, rules, and policies established by Carter County Emergency Management, the Carter County CERT, CERT leadership and instructors, and to exercise reasonable care while participating in the CERT program.

I understand that I can be administratively removed from the program at any time. Additionally, I authorize the use of my image, photographed in connection with my participation in the program, without prior approval or compensation. I understand that my submission of this application, whether mailed, emailed, entered online or faxed, will have the same force and effect as an original. Further, I understand that a background check will be required for all applicants, and my acceptance into the program is subject to clearance of the background check.

By submitting this online application, I authorize Carter County Emergency Management to require a background check, including a check of criminal records, and other information regarding me, that may be of a confidential nature. I understand that the background check results do not have to be disclosed to me. By executing this release, I certify that I have read this release in its entirety, understand all of its terms, and have had any questions regarding the release satisfactorily answered. I submitt this release and application freely and voluntarily.