CERT Final Drill Volunteers - City of Carpinteria

Help your local Community Emergency Response Plan (CERT) team by volunteering for the Spring 2025 Cohort’s Final CERT Drill.

We’re looking for volunteers to play a variety of roles – from people with minor inquires to those needing rescue.

No acting experience necessary. You’ll be given short scenario and basic moulage (fake injury makeup).

The final drill will take place at the Carpinteria City Hall (Council Chamber Area) on July 1, 2025 from 6-9 pm. Please complete a volunteer registration form below. If you have any questions, please email julizab@carpinteriaca.gov

CERT Final Drill Volunteer Registration

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PARTICIPANT’S INFORMATION

Name*

First Last

Email*

Phone*

Address*

Street Address Address Line 2 City State ZIP Code

Date of Birth*

Occupation*

Emergency Contact*

First Last

Relationship*

Emergency Contact Phone*

Do you have any limitations related to health or physical ability? If so, please explain.

PARTICIPANT’S RELEASE WAIVER, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

In consideration of the acceptance of the application as a participant in any emergency preparedness programs and/or activities of the City of Carpinteria, I hereby agree to assume all risks attendant upon myself while participating in any City of Carpinteria emergency preparedness programs and/or activities. I acknowledge the following: that participation in this program or activity is voluntary and may involve physical activity. I agree as to myself and for my heirs, personal representatives or assigns, to hereby assume the risk of any injury from any cause whatsoever, including the negligence of the City; and to give up, waive, and discharge and release the City of Carpinteria, the Corporate Sponsors of this program, their respective officers, volunteers, agents, and employees, from any and all claims for loss or damage, for personal injury, bodily injury including death, or property damage and I agree to hold the City and Corporate Sponsors harmless, and covenant not to sue the City or others listed herein, should property loss, injury, or death occur during or as a result of my participation in this program. By signing below, I acknowledge that I have read this assumption of risk, waiver and release of liability agreement, fully understand its terms, and I understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing this agreement freely and voluntarily, and intend by my signature for this to be a complete and unconditional release of all liability to the greatest extent of the law I hereby waive, release, and discharge any and all claims for damages for death, personal injury, or property damage which I may have, or which may hereafter accrue to me as a result of my participation in the City of Carpinteria program or activity. I agree to indemnify and hold the City of Carpinteria and Corporate Sponsors harmless from liability. Further, I understand the City of Carpinteria, the Corporate Sponsors of this program, their officers, volunteers, agents, and employees are not responsible for the personal property of the participants in any emergency preparedness program or activity.

VIDEO-PHOTO RELEASE

I understand that during the City of Carpinteria program and/or activity, my photograph may be taken by the City of Carpinteria, producers, sponsors, organizer, and/or assigns. I agree that my photograph, including video photography, film photography, or other reproduction of my likeness may be used without charge by the, producers, sponsors, organizers and/or it’s assigns for such purposed as they deem appropriate.

Signature*

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CERT Final Drill Volunteer Registration

PARTICIPANT’S INFORMATION

PARTICIPANT’S RELEASE WAIVER, ASSUMPTION OF RISK AND INDEMNITY AGREEMENT

VIDEO-PHOTO RELEASE