Consumer Health and Food Safety
3950 S. Country Club Rd., Suite 100
Tucson, AZ 85714
(520) 724-7908
www.pima.gov/health
POOL CERTIFICATION CLASS
REGISTRATION FORM
To register for a Pool Certication Class, please complete this form, pay the $30 registration fee, and submit
any additional required paperwork. For your convenience, we oer several registration and payment
options:
• Mail: Enclose registration form (one registration form per person) along with proof of citizenship or
lawful presence in the United States (i.e. U.S. driver’s license) A.R.S. 41-1080 and $30 check or money
order payable to: Pima County Health Department OR PCHD. Registration form must be received one
week before the class/exam.
• In Person: Register at 3950 S. Country Club Rd, 2nd Floor, Suite #2301. Pay the $30 fee with cash, check,
money order, MasterCard or Visa one week before the class/exam.
• Email: Send a scan copy of the registration form and proof of citizenship or lawful presence in the United
States (i.e. U.S. driver’s license) A.R.S. 41-1080 to chfs@pima.gov and pay the registration fee by phone
with a Mastercard or Visa.
The class and exam will be held at the Abrams Public Health Center, 3950 S. Country Club Road. Registrants
will receive a conrmation letter with the class date and time one week before their scheduled class date.
Individuals who register by mail will receive the class information to their mailing address.
If you require special accomodations for eective participation, please call 724-7908 to make arrangements
and check for availability of services.
The $30 registration fee is non-refundable: If you are absent on the class/exam date, you must take the
exam in the oce or register for another class date, subject to availability.
• Please specify certication registration:
p OPERATOR
p TECHNICIAN
PLEASE PRINT
Last Name: ______________________________ First Name: ______________________ M.I. ______________
Mailing Address: __________________________City: _________________ State: _______ Zip Code________
Phone: __________________________________E-mail Address: ___________________________________
Amount Enclosed: _____________
CLASS DATES
1st Choice: ____________________________
2nd Choice: ____________________________
3rd Choice: ____________________________
3969-031317-jc
