Grace Health Centre's Online Hold Me Tight Let Me Go Family Relationship Education and Enhancement Program Application Form 惠恩診所舉辦 緊繫我心 讓我飛翔 線上家庭關係教育課程申請表 (Each family member must register on separate forms 每個家庭成員必須各自分別填寫報名表)

This powerful, transformative, attachment focused, online program based on Emotionally Focused Family Therapy is currently limited to families with adolescent (10-25 years old) or adult children who are residents of Ontario.  The demand for this program is expected to vastly exceed the number of spaces, please apply as soon as possible.  Only families in which all participating members have completed the application and mandatory pre-course assessments will be considered.  Additional sessions may be added according to demand.
這具有能力更新家庭關係,以依附為重點,基於情緒取向家庭治療的線上課程,目前僅限於有青少年(10-25歲)或成年孩子的家庭,並屬安大略省居民。我們預計此課程的需求遠超名額,請盡快申請。所有參與的家庭成員必須完成申請表和課程開始之前的評估。我們可能根據需要添加其他日期。
Applicants will receive confirmation of the program and time prior to the start of the course.  If the scheduled program is full, applicants will be placed on a waiting list for future programs.  Families on the waiting list are encouraged to start using the workbook, program audios and videos to familiarize yourselves with the program.
申請者在課程開始前會收到通知確定修讀的課程和時間。如果預定的課程已滿,申請人將被列入未來課程的候補名單。我們鼓勵等待名單上的家庭開始使用作業簿,課程音頻和視頻,以使自己熟悉該課程。

Date and time 日期與時間:
Friday, July 31, 7:00pm-9:00 pm (information, Questions and Answers session for all applicants 為所有的申請者而設的諮詢,問答會議)
HMT LMG Program for families that are accepted 被接受參加 緊繫我心 讓我飛翔 的家庭
Friday, August 14, 7:00pm-10:00 pm (Parents only 家長)
Saturday, August 15, 10:00 am-1:00 pm, 2:00-5:00 pm (Parents and Adolescent Children 家長與青少年子女)
Saturday, August 22, 10:00 am-1:00 pm, 2:00-5:00 pm (Parents and Adolescent Children 家長與青少年子女)
Follow up session will be scheduled approximately 6 months after the program 課程後約6個月會安排跟進

Trainer 培訓師: Dr. Tat-Ying Wong 黃達瑩醫生 (International Center for Excellence in Emotionally Focused Therapy Certified EFT Therapist, Supervisor and International Trainer 情緒取向治療追求卓越國際中心認証治療師,督導及國際培訓師) https://iceeft.com/iceeft-trainers/

Information on the Hold Me Tight Let Me Go Family Relationship Education and Enhancement Program 關於 緊繫我心 讓我飛翔 家庭關係教育課程的資料:
Introduction by Drs. Paul and Nancy Aiken (1:07): https://youtu.be/HzsOUFXbjBo 
Introduction by Dr. Sue Johnson (4:13): https://youtu.be/idFF29x9UFc
Introduction by Adolescent in English by Yusha (1:49): https://youtu.be/iURPI8qu9bY
Introduction by Adolescent in English by Jessica (3:03): https://youtu.be/U4JIMrMQVSc
Introduction by Adolescent in English by Fred (3:04): https://youtu.be/k2vMu0GXcmE
Introduction by Adolescent in Cantonese by Yusha (1:35): https://youtu.be/ZQSl8QEdXJs
Introduction by Adolescent in Mandarin by Jessica (2:32): https://youtu.be/M7ouvV-ioHQ
Introduction by Adolescent in Mandarin by Fred (3:24): https://youtu.be/BKp8fhbQFCg
Introduction by Parent in Mandarin by Julia (2:43): https://youtu.be/zSFkmzlJhIs
Introduction by Psychotherapist in Cantonese by Elden (7:49): https://youtu.be/I0ozTjFKBN4
Information on Grace Health Centre 有關惠恩診所輔導: www.gracehealthcentre.ca/counselling
Enquiry:查詢: efttorontotraining@gmail.com


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Email *
Chinese Name 姓名(中)
Last Name (姓-英) *
First Name (名-英) *
性別Gender *
通訊地址 Address: 街道 Street *
城市 City,  省份 Province *
郵區 Postal Code *
家居電話 (Home Phone) *
手提電話 (Cell Phone) *
確認電郵地址 (confirm Email) *
醫療保險資料 Health Card Information(當惠恩診所的醫生帶領心理教育小組或課程時,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 Dr. Wong and Dr. Chen cannot charge for their services for leading psycho-educational groups and must be paid under OHIP by law)
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If you need a medical assessment, medication or referral to specialist, please enquire with the doctors at Grace Health Centre)
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
醫療保健卡上的姓名 Exact Name on Health Card *
醫療保健卡號碼與字母 Health Card Number and Version Code *
醫療保健卡上的出生日期 Birthday (年/月/日 Year/Month/day) *
參加課程的角色 Your role in attending this program *
言語 Language spoken *
Required
參加課程的家人姓名和電郵 Names and emails of family members attending program (每個家庭成員需各自報名 Each family member needs to register on separate application forms)
你從何途徑得知這課程 How did you find out about this course? *
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 or trainees, they are not acting as a professional counsellor in their role as course facilitator. 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或受訓者,但他們在課程中並不是擔任專業治療師的角色。
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  may choose to work through the program under the guidance of a helping professional trained in Emotionally Focused Family Therapy and can keep the program resources that were purchased. 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可以選擇在完成情緒取向家庭治療培訓的專業助人人士的指導下完成該課程,並且可以享用已購買的課程資源。
3. Most participants will benefit from listening to the audio content several times to improve comprehension and retention. 大多數參加者會多次收聽音頻內容而得益,並提高理解和吸收。
4. Attendance of all the sessions, engaging with the audio and written course material for each session and participation in the in class discussions, sharing, self-reflection and attachment building games and activities is mandatory. 學員必須投入每課堂的音頻和書本教材,以及參與課堂中的討論,分享,自我反思和培養依附的遊戲和練習。
5. For optimal learning, parents or parent figures need to set aside time before and after the program to listen to the audio content at least once. The audios can be loaded on smart phones and used while doing chores or exercise for most efficient use of time. 為了獲得最佳的學習效果,家長需要在課程前後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 growth and relationships are my own responsibility and am willing to take this responsibility by facing myself, engaging and renewing 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. 我承認個人成長和關係是我自己的責任,我願意通過面對自己來承擔這責任,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 at the time of application, beginning and end of the course and follow up 6 months later to gauge their progress and encourage self-awareness and self-reflection, the first step in personal growth and building secure attachment. 參加者還需要在申請,課程開始和結束,6個月後的跟進時完成自我評估,以衡量他們的進步,並鼓勵自我察覺和自我反思,這是個人成長和建立安全依附的第一步。
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 / Fee items 投資/費用項目 (Includes fee for assistants, copy right, eBooks, 26 audios for parents, over 40 videos 包括助理導師費,版權費,電子版課本,給家長的音頻x26,給家庭的視頻x40+) (For family of 4 with 2 children, works out to less than $5 per family member per hour 有兩個孩子的四口之家,每個家庭成員每小時少於$5) *
Required
If you are a helping professional and interested in the HMT LMG facilitator training please indicate your qualifications and license number 如果你是專業助人人士,並且對帶領 緊繫我心 讓我飛翔 家庭關係教育課程的培訓有興趣,請填寫你的專業資格和執照號
Helping professional regulatory body and license number 專業助人人士監管機構和執照號
Program fee can be paid using Interac e-Transfer to efttorontotraining@gmail.com 交費可以使用 e-transfer 方式進行.  賬戶電郵: efttorontotraining@gmail.com  Please list your family member's names and password for the e-Transfer in the remarks / text box. 敬請於備註欄中註明家庭成員姓名及e-Transfer密碼。If you are paying by cheque, please write down the name of your bank and number of your cheque. 如果寄支票惠恩診所,請寫下銀行與支票號碼 (payable to: Dr. T.Y. Wong MPC, 2830 Keele St., Suite 402, Downsview, Ontario, Canada M3M3E5) *
If you are paying by cheque, please write down the name of your bank and number of your cheque. 如果寄支票惠恩診所,請寫下銀行與支票號碼 (payable to: Dr. T.Y. Wong MPC)  If another family member paid for your family, please write down his / her name and email. 如果其他家庭成員為你的家庭付款,請寫下他/她的名字和電郵。
Please complete the following evaluation at the time of application, beginning and end of the program and at 6 month follow up.  Applications are deemed incomplete and won't be considered until all the family members have completed the evaluation. 請在申請時,課程開始和結束時以及接下來的6個月內完成以下評估。 只有在所有家庭成員都完成評估後,申請表才會被接受。Assessment for parents 給家長的評估: https://www.gracehealthcentre.ca/node/68  Assessment for children 給孩子的評估:  https://www.gracehealthcentre.ca/node/79  Comments, questions, suggestions 意見,問題,建議:
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