ASIST V.12 Registration Form

ASIST V.12 Registration Form
Thank you for your interest in registering for Applied Suicide Intervention Skills Training (ASIST).
This training is a two-day in-person workshop where you’ll learn how to recognize when someone may be thinking about suicide and how to provide a skilled Suicide First Aid intervention.

LivingWorks ASIST is rooted in adult learning principles and emphasizes hands-on practice, helping you build confidence and skills in suicide intervention. Upon completion, you will recieve a Certificate valid for three years.

If you have any questions, please email dawsong103@gmail.com
Notice: This workshop is not available to paid staff of Family Services of Greater Vancouver or Directions Youth Services.
Program Dates

If the workshop that you are trying to join is currently full or if there are no dates available, please email dawsong103@gmail.com and ask to be added to the waitlist.
Choose the date of the workshop and the number of seats you would like to purchase.
Program Information
- This training course is suitable for individuals aged 16 and older.
- Attendance of two full days is required to receive a certificate of completion.
- Group discussions are emphasized in this workshop. Active participation is strongly encouraged to support your learning and the learning of others.
- LivingWorks ASIST deals with attitudes, experiences and feelings around suicide and can be emotionally intense.
- If you have been recently affected by suicide or suicide loss or are currently struggling with suicide, please consider if it is the right time to take the course. Feel free to get in touch, or talk with the facilitator beforehand.
Acknowledgement
Have you been impacted by suicide loss in the past 12 months?
Participant Information
Please write your name as you would like it to appear on your certificate.

First NameLast Name
Pronouns
Please enter if you would like your pronouns to be displayed on your name tag.
Organization
Job Title / Role
Email Address
Please note that if you register with a work/school email, you will lose access to your LivingWorks Connect account if the email address is disabled. Personal emails are recommended.
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
What area or community do you call home?
Do you have any accessibility needs? If yes, please describe.
Do you have any dietary restrictions or allergies? If yes, please describe.
Is there anything else you would like us to know?
Cancellation & Transfer Policies
Registrations are confirmed upon receiving payment.

 If you can’t attend the training you’re registered for, there are three options:

 1. Send someone in your place: This will not incur an administration fee. Please notify us of the new individual’s first and last name and email address with as much notice as possible before the program start date.

 2. Transfer your registration to another date: This will incur a $25 admin fee. Please choose a new date to take the workshop and contact us. Transfers will be subject to availability. We cannot accept requests to transfer less than 10 days prior to the program start date.

 3. Cancel your registration: We can offer a refund 10 days prior to the program start date. This will incur a $50 administrative fee. No refund will be provided if your request is within 10 days of the program start date.

We reserve the right to cancel workshops if minimum registration numbers are not met; in the event that we elect to cancel a workshop, full refunds will be issued.
Acknowledgement
Illness Policies
For the safety of everyone, we kindly ask that you stay home if you are sick. Masks are strongly encouraged for anyone recovering from illness or who may have been exposed to illness through close contacts (e.g., child, coworker, roommate, partner).

If you are unable to attend due to illness, please contact dawsong103@gmail.com as soon as possible to discuss rescheduling or other options.
Acknowledgement
Payment
The standard rate per participant is $325 CAD. Methods of payment are e-transfers or cheques.

Subsidized rates are also available. Rates vary depending on the number of participants that pay the full standard rate.

If the standard rate is affordable to you, thank you for helping to make this training more accessible to low-income participants.

If cost is a barrier to your participation, please contact dawsong103@gmail.com.
Please make your selection below.
Contact dawsong103@gmail.com for the current subsidized rate.
Please write your name as you would like it to appear on the invoice.

First NameLast Name
Address for Invoice

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address for Invoice
example@example.com
An invoice will be sent to reserve your seat. Please note, seats are confirmed upon receiving payment.
Consent to Collect & Share Personal Information
By submitting this registration form, you consent to the collection of your personal information, including your first and last name and email address, for the purpose of providing you with LivingWorks ASIST training, certification upon training completion, and access to LivingWorks Connect.

You also authorize us to share this information with LivingWorks in order to enable them to provide the services to you. Your information will be handled in accordance with LivingWorks' Privacy Policy. You may withdraw your consent at any time by contacting LivingWorks (privacy@livingworks.net), though doing so may affect the ability to provide the service.
Acknowledgement
Thank you for your time!
Should be Empty:

ASIST V.12 Registration Form

Thank you for your interest in registering for Applied Suicide Intervention Skills Training (ASIST).

Program Dates

Program Information

Participant Information

Cancellation & Transfer Policies

Illness Policies

Payment

Consent to Collect & Share Personal Information

Thank you for your time!