To participate in the TTSL program you must be at least 13 years of age. If you are between the ages of 13-18, fill in the TALKER section and have your RESPONSIBLE ADULT fill out the rest. If you are 18 years of age or older, fill out the entire form.
If you are under 13, please email: Team@JackieSimmons.com for other options.
I am *
TALKER: What name do you prefer to be called? *
TALKER: What email do you want us to use to reach you? *
TALKER: What is your age in years? *
TALKER Promise: I will show up for class, I will practice "The Talk" that Saves Lives and I will "report" on my practice partners . . . (not their names, just their answers.) *
RESPONSIBLE ADULT: By filling out this section, I certify that I am legally able to give permission for the TALKER above to participate in the TTSL program
TALKER: If you are 18 years of age or older, you must fill this section out for yourself.
RESPONSIBLE ADULT: What is your name? (first and last names please) *
RESPONSIBLE ADULT: What is the TEEN-TALKER's name? (first and last names please)
RESPONSIBLE ADULT: What email address do you want us to use for contacting you, if different than above?
RESPONSIBLE ADULT: Please give us your phone number/What'sApp number, or permission to contact the TEEN-TALKER and their Phone Number/WhatsApp Number. *
Phone Number/WhatsApp Number (Please include the dashes in your phone#) *
Please provide your timezone *
RESPONSIBLE ADULT: I Promise that I will support my TALKER at whatever level they choose to participate in TTSL. I promise that I will be available for planned practice talks. I PROMISE that I will not question, comment, or nudge my TALKER to do more. ( If the urge to question, comment, or nudge becomes too great, I promise to email Team@JackieSimmons.com for assistance in staying out of "corrective complex.") *
How did you hear about "'The Talks' that Save Lives?" *
"'The Talks' that Save Lives" program is based on the award-winning "Suicide Prevention Advocate Training" program and is designed to further the mission to make teen suicide a thing of the past. We are NOT an intervention program. If you, or a loved one, is actively struggling with suicidal thoughts, seek intervention via a crisis hotline or emergency room. 1-800-273-8255 is the Suicide Prevention Hotline in the U.S.A..
Please watch Jackie's TEDx talk all the way to the end and then comment, like, and share it. You'll never know whose life you'll save. To watch Jackie's TEDx talk go to: www.TeenSuicidePreventionSociety.com