Author: Terri Black

Employer: ____________________________________
Work Address: ________________________________
____________________________________________
Work Phone: _________________________________
Fax: ________________________________________
Where should your confirmation and certificate be mailed?
_____ Personal Address _____ Work Address

Name: ____________________________________
Personal Address: ___________________________
__________________________________________
__________________________________________
Daytime Phone: ____________________________
Email: ____________________________________

No Refunds!!!
Payment along with completed registration form must be received by October 8, 2021

ServSafe® Manager Certification Course
October 11, 2021 Sandersville, GA

This nationally-recognized course is certified through National Restaurant Association Educational Foundation and includes:
Your course book, ServSafe® Manager, NEW Seventh Edition. This is the only acceptable book for this course. (Newest edition out.)
Eight hours of instruction by experienced, ServSafe® Certified Instructors from The University of Georgia Cooperative Extension.
Upon passing the exam, you will receive a ServSafe® Food Protection Manager’s Certificate from the National Restaurant Association.
The Certification Test: Can You Pass It?
The ServSafe® Certification Exam is given at the end of the course. The exam is a standardized test, and requires good reading and comprehension skills. It is strongly recommended that you begin studying the book as soon as you pick it up. During the course, please plan time in the evening to study as well.
How Do I Register for the Class and Exam?
The registration form is attached, and the fee is $140.00.
Your seat in the class is not reserved until form and fees are received.
Registration deadline: October 8, 2021. Your course book should be available for you to pick up the day you register.

ServSafe® 1-Day Course—$140
Re-Test—$65 (Select only if you recently tested, but did not pass.)
Are you recertifying?
Yes No

Language Preferences

Book
English
Spanish
Chinese
Korean

English
Japanese
Spanish
Korean
French/Can.
Chinese
Instructor

Exam

Passing this course will also meet the Georgia Department of Public Health and Georgia Department of Agriculture certification recommendations for store, deli, and kitchen managers.

Tentative Schedule

Registration Form for Manager’s Course
Feel free to copy this form and distribute to all managers or manager-trainees. Please complete both sides of form and use only one form per student.
Please read carefully and answer all questions. If you have recently taken the exam, but did not pass, you may select re-test for $65.00. This option includes only the exam and course instruction.
Course books will be available for pick up at the Washington County Extension office at anytime upon paid registration. Course books can be mailed to you for an additional $6.00 fee, payable at time of registration. If you have questions, please call
Georgeanne Cook at (478) 552-2011.
______ Full Registration $140.00
______ Retest $65.00
______ Postage $6.00 (Pay only if you would like course book mailed.)
______ Total Amount Paid
Complete this form and mail with registration fees to:
Washington County Cooperative Extension
PO Box 310
Sandersville, GA 31082
Make checks payable to: Washington County Extension/4-H
DISCLAIMER: The information presented in the ServSafe Course as well as within the ServSafe book and related materials have been compiled from sources and documents believe to be reliable and represent the best professional judgment of the National Restaurant Association Educational Foundation. The accuracy of the information presented, however, is not guaranteed, nor is any responsibility assumed or implied by the national Restaurant Association Education Foundation, the Georgia Restaurant Association (GRA), the GRA’s employees, contractors, instructors or agents for any damage or loss resulting from inaccuracies or omissions. Laws may vary greatly by city, county, or state. The documents prepared and the courses delivered are not intended to provide legal advice or establish standards of reasonable behavior. Operators who develop policies and procedures as part of their commitment to employee and customer safety are urged to use the advice and guidance of legal counsel.
Signature Date

Classes will be held at the Washington County UGA Extension Office, 158 West Haynes Street, Sandersville, GA 31082
Monday, October 11, 2021
08:30 am Register and sign-in
08:45-12:15 Part 1: The Challenge to Food Safety
12:15-12:45 Lunch on your own
12:45-3:00 Part 2: The Flow of Food
3:00 - 5:00 Review & Certification Exam
***** Maximum number of participants is 5. Notice to participants not to come if feeling sick or if they have been exposed to Covid-19. Social Distancing and Masks are required. Plan for intake interview. Social distancing is in place. Pre-registration for event is required. *****
If you have any questions about the course, registration, or if you need directions, please contact:
Georgeanne Cook
Washington County Extension
158 West Haynes St
Sandersville, GA 31082
(478) 552-2011
Special arrangements for persons with disabilities will be made if requested in advance. To make arrangements, or for more information, call the Washington County Extension Office at (478) 552-2011 upon registration. The University of Georgia Cooperative Extension offers its educational programs, assistance, and materials to all people regardless of race, ethnicity, disability, or veteran status, and is an equal opportunity, affirmative action organization.

Please cut and return this portion with your payment.