One-day CISM Refresher Training: Sudbury, Ontario, November 28, 2019

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Please take a moment to complete the following information regarding the upcoming training. Note that either the ICISF Assisting Individuals in Crisis or ICISF Group Crisis Intervention course is a pre-requisite for this training day.

Email *

Please enter your name as you would like to be addressed during the training. *

Please provide your current position/role at work that resulted in you taking this training. *

Which ICISF courses have you taken in the past? Please check all that apply: *

ICISF Assisting Individuals in Crisis

ICISF Group Crisis Intervention

ICISF Strategic Response to Crisis

ICISF Suicide Intervention Training

None - I'm trying to sneak onto this training to see what it's all about.

Other:

Required

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. *

1-5

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? *

1-5

5-10

10 or more

I understand that the class will run from 8:00 am to 5:00 pm. Role-play and simulation exercises will be a key part of the course. *

Yes, no problem.

I'll come but you'll never make me participate!

Required

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 something 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 if one was indicated above. If possible, it will be avoided as a role-play scenario for the training.

Please provide any information about yourself that you feel may be helpful for the trainer to know in advance.

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 and a 2% convenience fee will apply

Non-refundable $100 deposit by credit card in advance. Full payment by cheque, cash, or e-transfer.

My employer is paying for this training and will handle payment.

A copy of your responses will be emailed to the address you provided.

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