Naloxone Training Course Registration Form

Naloxone Training & After Care Course

Date:

Time: 6:30pm-8:00pm

Location: ACT - 543 Yonge Street, 4th floor, Toronto

TOMQ and ACT will be hosting an in-depth Naloxone training and after care course for gay, bi, queer, trans guys, and trans folks who do sex work, PnP, and those who intersect those communities. Attendees will learn how to correctly and effectively administer Naloxone and tips for providing and accessing aftercare and support.

Questions? Email kphillips@actoronto.org

Location

Date

Time

ACT

543 Yonge Street

4th floor

Toronto

Wednesday January 18th 2023

6:30pm - 8:00pm

Itinerary:

Time (pm)	Task
6:30 - 6:45	Welcome & Food
6:45 - 7:30	Presentation
7:30 - 7:45	Questions harm reduction pickup
7:45 - 8:00	Harm Reduction Supply Collection, Q&A

FREE Harm reduction materials (barriers, masks, hand sanitizer, sun screen, safer PnP materials, resources etc.)

A meal and a return TTC ticket will be provided to all in-person participants. An online link will be available for folks to tune in and participate virtually. Ask questions, participate in games and win prizes.

Questions about Chem Sex? Email kphillips@actoronto.org to propose a question and we will try to answer it during the workshop.

Register to secure a meal

Name*

Aliases/ social media tag / whatever we can call you

Pronouns*

(He/She/They/It/Xir)

Email*

example@example.com

I will be Attending*

In PersonOnline

Do you have any allergies/ dietary restrictions?*

YesNoOnline

If yes, please list them here:*

If none, write “N/A”

I will be bringing a guest*

YesNo

Name*

Aliases/ social media tag / whatever we can call you / NA no guest

Pronouns*

(He/She/They/It/Xir)

Does your guest have any allergies/ dietary restrictions?*

YesNoNo GuestOnline

If yes, please list them here:*

If none, write “N/A”

Questions about Naloxone

ex. "Where can I get Naloxone?"

Questions, Comments, Concerns

ex. "Will there be vegan meal options?", "Can I bring a friend?"

DISCLAIMER

Priority is given to Black and Indigenous Trans people of colour.

Note that all information shared on this form is confidential and will not be used or shared outside of the ACT (Formally the Aids Committee of Toronto).

Discrimination, Racism, Transphobia, Abuse or any hate of any kind will not be tolerated in this space. You will be asked to leave and then removed from the space.

Aliases are accepted and encouraged. This is to ensure the safety of the space.

Public washrooms are available onsite. Please be respectful.

By submitting the form you consent and acknowledge the disclaimer statement and agree to abide by the terms of service.

I have read the disclaimer and agree to abide by all terms expressed above.*

Yes, I agree.

I am interested in taking an evaluation survey at the end of the event for a $5 Tim Horton's Gift Card*

YesNo