惠恩診所主辦: 情緒取向治療追求卓越國際中心 (ICEEFT) 認證專業培訓 “抱緊我/生為連結”(促進伴侶連結教育小組)體驗工作坊 報名表
GRACE HEALTH CENTRE: ICEEFT Certified Hold Me Tight/ Created for Connection Couple Relationship Enhancement Educational Program Group Facilitator Training Registration Form
Date 日期: Feb. 18-19, 2020年2月18 及19日 (星期二及三 Tues & Wed)
Time 時間: 9:15 am-5:00 pm 上午九時15分至下午五時 (共15小時)
Location 上課地點: Richmond Hill Christian Community Church城北華人基督教會, 9670 Bayview Avenue, Richmond Hill, Ontario L4C 9X9 (D53-55課室) www.rhccc.ca
有關“抱緊我/生為連結”促進伴侶連結教育小組: https://iceeft.com/what-is-hold-me-tight/
有關惠恩診所輔導: www.gracehealthcentre.ca/counselling
Email address *
姓名(中) *
Your answer
Last Name(英) *
Your answer
First Name(英) *
Your answer
通訊地址 Address: 街道 Street *
Your answer
城市 City, 省份 Province *
Your answer
郵區 Postal Code *
Your answer
家居電話 (Home Phone) *
Your answer
手提電話 (Cell Phone) *
Your answer
確認電郵地址 (confirm Email) *
Your answer
Languages that you understand 你明白的語言 *
Required
How did you hear about this training 你是如何得知本次培訓? *
Required
Name and email of person who referred you if applicable 推薦者的姓名和電郵 *
Your answer
醫療保險資料: 醫療保健卡上的姓名 Exact Name on Health Card *
(當惠恩診所的醫生協助教育小組或課程時,無論是黃醫生或陳醫生,法律上只可從安省醫療保健計劃收費,不可從病人收費)
Your answer
醫療保健卡號碼與字母 Health Card Number and Version Code *
如果參加者需要醫生作評估,吃藥,轉介專科醫生或其他的資源,請詢問惠恩診所的醫生詳情可參黃醫生和陳醫生在惠恩診所網站上有關輔導的資料: www.gracehealthcentre.ca/counselling
Your answer
醫療保健卡上的出生日期 Birthday (年/月/日 Year/Month/day) *
Your answer
所屬教會 Church (如果不是信徒,請填寫"未信") *
Your answer
Participant’s Agreement 參加者同意書 *
1. This is an educational program that does not replace the need for professional help and medications. Participants need to continue their current treatment during the course. Even though the facilitators are trained and licensed mental health professionals, they are not acting as an individual therapist in their role as course facilitator. The course material are presented from both a Christian and scientific perspective. If this perspective is not acceptable to you, then this course may not be appropriate for you. 這教育課程不能取代專業的幫助和藥物。參加者需要在課程期間繼續目前的治療。儘管課程導師是受過培訓並獲得牌照的精神衛生專業人士,但他們在課程中並不是擔任個人治療師的角色。課程教材是基於基督教和科學的角度。如果你不能接受這觀點,那麼本課程可能不適合你。2. Participants need to be stable, able to commit the time required, concentrate, absorb the key concepts, complete the basic exercises and not to be at risk to themselves or others so that a safe and productive learning environment can be maintained. The facilitators will ask participants who need additional help to consult their helping professionals. Participants who are not suitable for the course will be provided with a refund less administrative charge of $20. 參加者需要能夠保持情緒穩定,付出所需的時間,集中精神,吸收重要的概念,完成基本的練習以及不要對自己或他人構成危險,以便保持安全和有效的學習環境。導師會邀請需要額外幫助的參加者諮詢幫助他們的專業人士。不適合此課程的學員將獲發還減除20元行政費後的退款。3. Most participants will benefit from listening to the audio content provided in the mp3 DVDs several times to improve comprehension and retention. 大多數參加者會多次收聽DVD中的音頻內容而得益,並提高理解和吸收。4. Attendance of all the sessions, engaging with the audio-visual and written course material for each session and participation in the in class discussions, sharing, self-reflection and skill building exercises are required for maximum benefit and growth. 為了得到最大收穫和成長,參加者需要出席所有的課堂,投入每課堂的影音和書本教材,以及參與課堂中的討論,分享,自我反思和培養技巧的練習。5. For optimal learning, participants are encouraged to listen to the audio content and review each lesson. The audios can be loaded on smart phones and used while driving, doing chores or exercise for most efficient use of time. 為了獲得最佳的學習效果,參加者需要每週安排時間來至少聽一次音頻內容並查看每課堂的資料。音頻可以加載到智能手機上,並在駕駛,做家務或運動時使用,以最有效的方法運用時間。6. Participants will keep the personal sharing and discussion confidential to protect each other’s privacy. 參加者將保密個人分享和討論,保護彼此的隱私。7. Participants who are absent for emergencies, illness and other reasons beyond their control are expected to notify the facilitator as soon as possible and to the best of their ability complete the work for the session that they have missed. 因緊急情況,疾病和其他無法控制的原因而缺席的參加者應盡快通知導師,並盡力完成缺席那一課堂的內容和作業。8. I acknowledge that my personal and relational growth is my own responsibility and am willing to take this responsibility by facing myself, allowing God to engage and renew my way of thinking, beliefs, attitudes, values, behaviour and experience without avoiding, blaming myself or others. I understand that I am fully and solely responsible for the results and decisions that I make regarding my use of this course. I release the facilitator, the program developer and all related institutions and organizations from any and all liability and accept full responsibility for my involvement in this course and the use of any related materials. 我承認個人和關係成長是我自己的責任,我願意通過面對自己來承擔這責任,容許神介入並更新我的想法,信念,心態,價值觀,行為和經歷,而不會逃避,指責自己或他人。我明白並對自己在此課程內所作的選擇和後果承擔所有責任。我允許導師,課程設計者,以及所有相關機構和組織免去所有的責任。我對參與此課程和使用相關教材願負全部責任。9. Participants can support each other through mutual acceptance, understanding, validation, empathy, prayer and encouragement. 參加者可以通過互相接納,了解,肯定,同理,祈禱和鼓勵來彼此支持。10. Participants are also required to complete self-assessments before and after the course to gauge their progress and encourage self-awareness and self-reflection, the first step in personal and relational growth. 參加者還需要在課程前後完成自我評估,以衡量他們的進步,並鼓勵自我察覺和自我反思,這是個人和關係成長的第一步。11. In emergency situations or times when the participant is at imminent risk of hurting him/herself or others, then he or she will need to go to the closest emergency department or call 911 for immediate assistance. 在緊急情況或參加者即將面臨傷害自己或其他人的危險情況下,參加者必須去最近的急症室或撥打911以獲得即時幫助。12. Participants may be involved in photographs, testimonies, and the production of short audio-visual clips for promotion and helping other course participants. 參加者可能會參與宣傳或幫助其他參加者的照片,見證和簡短的音頻或視頻的製作。I have reviewed, understand and agree to follow the above.我已經讀完,理解並同意遵守上述的條件。
Investment 投資 *
報名費包括: 生為連結促進伴侶連結教育課程的課本x2; 抱緊我/緊繫我心 讓我飛翔/情緒取向治療 促進關係連結卡; 親密美滿關係的秘訣 (課程一至三, 共30課, 約30小時, 雙語(粵/國) mp3 DVD; 親密美滿關係的秘訣 (課程一至三, 共30課, 約30小時, 雙語(粵/國) 網上視頻; 親密美滿關係的秘訣 (課程一至三) 課本 x3; 建立美滿不能破裂的婚姻 (課程一至六, 共66課, 約60小時, 粵語) mp3 DVD
Name of group members / partner 五人以上組員 / 伴侶姓名
Your answer
Payment 付款 *
Cheque Number and Bank 支票號碼及銀行名稱
Please send cheque to: Dr. T.Y. Wong MPC, 2830 Keele St., Suite 402, North York, ONTARIO M3M3E5
Your answer
Questions, suggestions, opinion regarding this training 有關這專業培訓課程的問題,提議,意見
Please email efttorontotraining@gmail.com if you have specific questions. A copy of this registration form will be sent to the email address that you have provided above for your record.
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy