Participant Registration for
Southeastern Virginia CERTEX 2008

Sponsored by the Portsmouth Local Emergency Planning Committee


What is Southeastern Virginia CERTEX 2008? The Southeastern Virginia CERTEX 2008 is a full scale mass casualty exercise involving both Community Emergency Response Teams and a variety of public safety agencies (Police/Sheriff, Fire, EMS, etc.).

Where:  The former Jeffrey Wilson Public Housing Complex, located next to the New Horizons Center (S. H. Clark Elementary School) at 2801 Turnpike Road, Portsmouth, VA 23707.

When: Saturday, 19 April 2008 from 7:30 am - 3:00 pm.

Who will be involved? CERTs from around southeastern Virginia and other public safety agencies.

CERT Members:  Our greatest need is for actual CERT members to portray themselves and respond to the exercise scenario presented to them.  The objective of this exercise is to test our CERTs on their core CERT skills as they respond to the incident portrayed in the exercise. 

Exercise Support Volunteers: In addition to the CERT members, we need other volunteers to help make this exercise a success. Here is a list of the Southeastern Virginia CERTEX 2008 volunteer opportunities:

Volunteer Position Title Position Description  No. of Volunteers Needed
Administrative Assistants Assist HRMMRS Staff Members with the registering exercise participants to include both check-in & check-out. 10
CERT Team Members To play themselves & function in accordance with their CERT training. (Each participant must have successfully completed CERT training in their community.) Unlimited
CERT Team Leaders To lead each CERT participating in the disaster scenario. 1 for each CERT
Greeters/Ushers To guide exercise participants to their designated positions & locations. 6
Logistics Support Specialists To assist with water & food distribution,  & other exercise support tasks. 6
Patients / Victims To act as disaster victims/patients. 50
Traffic Control / Parking Attendants To assist with traffic control and parking at the exercise location. (Individuals should be trained in traffic control procedures.) 10

Volunteer positions will be filled on a "first come- first served basis".    If the volunteer position that you registered for has been filled our Volunteer Coordinator will notify you and ask if there is another position that may interest you. 

Does everyone need to register? YES! We need everyone participating in the exercise to register as we must maintain accountability of all persons at the exercise site. We also need to know how many participants we will have so that we order appropriate quantities of water, food, and other items which are needed to support the exercise.

How do I register?
1.  To register please read the contents of this web page including the Participant Waiver.
2.  Complete the registration form below and click the Submit button.  Immediately upon clicking the "Submit" button you will be sent to the "Confirmation Page".
3.  Print out the Confirmation Page and bring it with you to the exercise.

How long will the exercise last?  The exercise scheduled to run from  7:30 a.m. until 3:00 p.m.  The exercise may also end earlier depending upon when the exercise objectives have been met.  However some people may need to arrive earlier and stay later depending upon their role in the exercise, for instance:

Volunteer "Patients" should plan on participating from 6:30 a.m. until approximately 3:00 p.m..

Administrative Assistants, Amateur Radio Operators, Exercise Evaluators, Greeters/Ushers, & Traffic Control/Parking Assistants, should plan on being at the exercise site no later than 6:30 a.m.

Where should I park?  Free parking is available at the former Jeffrey Wilson Public Housing Complex. You will directed to the parking area upon your arrival at the exercise area.

How do we check-in at the exercise site?  We need to maintain 100% accountability for everyone who is "on-scene" at the exercise just like we would during a real incident or disaster. All participants and volunteers must check in at the Registration Desk.

How do we check-out of the exercise site? Simply return to the Registration Desk to check-out before departing the exercise location.

What should I wear?  Please dress for the weather but wear old clothing that you do not care about. Volunteers who are serving as "patients" MUST wear clothing that can get wet, dirty, stained with moulage blood and possibly  CUT OFF of them. "Patients" are also asked to bring a dry change of clothes, toiletries, plus towel & washcloth.  This will ensure that you can get cleaned up and put on dry, clean clothing when your role in the exercise is over.

What if I sign-up to volunteer and then I am unable to attend?  Contact Ms. Tonya Cook or Ms. Stephanie Hackett, the CERTEX 2008 Registration Coordinators, as soon as possible so that they can arrange for a replacement. Tonya  and Stephanie can be reached at the Tidewater Emergency Medical Services Council /HRMMRS Program Office at telephone (757) 963-0632 or via e-mail at hrmmrs@vaems.org.


Southeastern Virginia CERTEX 2008
Participant Registration Form

All exercise participants are requested to register to participate in CERTEX 2008 by completing the form below:

Exercise Date                       

Select Your Role in the Exercise Role:     

Participant Demographic Information:  The following information will be used to contact you regarding your participation in the CERTEX 2008 exercise. This information will NOT be shared with any agency or organization that is not directly involved with this exercise.

Title:                                          

First Name:                             

Last Name:                           

Street Address 1:                 

Street Address 2:                

City:                                           State:       Zip Code:   

Agency/Organization:       

Primary Email:                     

Secondary Email:                

Contact Phone Number:           (Please enter in (###) ###-#### format.)

For Volunteer "Patients" Only: Do you have any allergies to latex, medications, or other substances? If none, so state.


Southeastern Virginia CERTEX 2008
PARTICIPATION WAIVER

I understand and acknowledge that my participation in the full scale public safety exercise known as "Southeastern Virginia CERTEX 2008”, is voluntary, and hereby for myself, my heirs and assigns, release, remise, and discharge the Portsmouth Housing and Redevelopment Authority, Portsmouth Public Schools, the City of Portsmouth, the Hampton Roads Metropolitan Medical Response System, and the Tidewater Emergency Medical Services Council, Inc., and its agents and employees from all claims, demands, actions and injuries, sustained to my person or property as a result of my participation in "Southeastern Virginia CERTEX 2008" on the premises of the former Jeffrey Wilson Public Housing Complex.

I am aware of the risks and dangers involved in my participation and that unanticipated and unexpected dangers may arise, and I assume all risks of injury to my person and property that may be sustained as a result and completely and fully release the Portsmouth Housing and Redevelopment Authority, Portsmouth Public Schools, the City of Portsmouth, the Hampton Roads Metropolitan Medical Response System, and the Tidewater Emergency Medical Services Council, Inc., from all liability.

I understand that all reasonable and customary safety measures will be performed to try to prevent injury or harm to me. I also understand that if at any time during this exercise I am uncomfortable, I possess an Emergency Card that I can display, which will alert exercise staff and other participants to render assistance to me, and/or excuse me from the exercise.

I represent that I am at least 18 years of age, or if I am under the age of 18 years old, that I am the parent or legal guardian of the participant named below and that he/she has my permission to participate in the "Southeastern Virginia CERTEX 2008" exercise and that I have full knowledge thereof.

By electronically submitting this form I am confirming that I have read and understand the information contained in this PARTICIPANT WAIVER.