Training Course Signup
Participant Registration Form
Name:
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
*
example@example.com
Phone Number
*
Must be able to recieve text messages
Please tell us why you want to train for crisis intervention:
Though we don’t force our beliefs on anyone, we train and operate from a Christian perspective. Are you willing to participate in this capacity?
Yes
No
Please tell us about any past experiences you have in crisis intervention:
Your safety and wellbeing are critical. Do you have any physical or mental impairments that may effect your work in crisis intervention?
Yes
No
If yes, please explain...
Have you ever been convicted of a felony?
Yes
No
If yes, please explain...
Have you or anyone in your household ever been convicted OR ACCUSED of inappropriate contact with a minor?
Yes
No
If Yes, please explain...
Have you ever been accused or convicted of domestic violence?
Yes
No
If yes, please explain...
Do you now or have you ever had a restraining order filed against you?
Yes
No
If yes, please explain...
Are you currently being treated for severe mental illness including but not limited to: schizophrenia, PTSD, major depressive disorder, extreme anxiety, a personality disorder or any other disorder which might affect the ability for you to help others and maintain appropriate boundaries?
Yes
No
If yes, please list and explain, including explaining any treatment you are undergoing:
Please list 3 personal references, not living with or related to you, that can vouch for your character (pastoral references are appreciated, if you have them!):
By clicking "Submit" you affirm and attest that the answers you have given in this application are true to the best of your knowledge. Understand that "yes" answers to the questions above does not necessarily negate your ability to receive training and provide volunteer services with us. You understand, also, that you are applying for a volunteer position and understand you will not receive any pay for your services. If you agree, please click submit and someone will contact you with the next step in the process.
Submit
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