2-Day CISM Training: Red Mountain Resort, Rossland, BC December 5-6, 2019
Please take a moment to complete the following information regarding the upcoming training.
Please enter your name as you would like it to be printed on your certificate including any designations.
I am also interested in the 2-day Assisting Individuals in Crisis training on December 3-4, 2019 for a combined price of $500. Please note that the Assisting Individuals in Crisis course will only be offered if minimum registration is reached.
Please provide your current position/role at work or in your personal life that resulted in you taking this training.
I am also interested in the 2-day Assisting Individuals in Crisis training on December 3-4 in Rossland, BC.
Maybe - please contact me.
What prior training do you have in either mental health awareness or emotional crisis intervention ? Please check all that apply:
No prior training in mental health/crisis intervention.
2-day Mental Health First Aid or similar training.
Prior training in ICISF Assisting Individuals in Crisis or Group Crisis Intervention.
I have attended workshops on mental health at conferences or other training events.
Professional training in assisting people who are in crisis.
How many personal traumatic events have you dealt with in the past year? e.g workplace incident, relationship ending, death of person close to you, etc.
5 or more.
In the past year, how many times have you helped someone who was going through a difficult time or had experienced a traumatic event?
10 or more
I understand that full attendance each day of the training and participation in class exercises is required to receive a certificate for the training.
Yes, no problem.
I'll come but you'll never make me participate!
I understand that traumatic events including workplace incidents, relationship stress, and suicide will be discussed during this training. I am responsible for my own self-care and will opt out if a subject is too sensitive for me to participate.
Yes, I understand.
There is a recent event that I would prefer to avoid during the training, please see my request below.
Please provide a brief outline of the recent event indicated above. If possible, it will be avoided as a role-play scenario for the training. Replies will not be shared with the class.
Payment of the course fee must be received or arranged prior to the training. Please indicate your method of payment.
Payment by credit card in advance of training - Instructor will contact you.
Non-refundable $100 deposit by credit card and full payment by cheque or cash on day 1 of training.
My employer is paying for this training and will handle payment.
Please provide any information about yourself that you feel may be helpful for the trainer to know in advance, including food allergies or other medical conditions that should be communicated to the other participants to ensure a safe learning environment.
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service