Summit Area YMCA May 2025 QPR Trainings

SUMMIT AREA YMCA

FREE QPR Suicide Prevention Trainings

QPR stands for Question, Persuade, and Refer - the 3 simple steps anyone can learn to help save a life from suicide.

Tuesday, May 13, 2025 at 7:00pm - 8:30pm

or

Saturday, May 24, 2025 at 11:00am - 11:30am

Please only pick one date.

BERKELEY HEIGHTS YMCA - 59 Locust Ave. Berkeley Heights

Please complete one registration form per person
Is the attendee 18 years of age or older?
PARTICIPANT INFORMATION
Guest Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Email
example@example.com
WHICH TRAINING WILL YOU ATTEND?
Member Status
- Parent/Guardian Name
  
  First NameLast Name
- Relationship to Minor
- Date of Birth
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit year
- Phone Number
  ex. 555-555-5555Format: 000-000-0000.
- Parent/Guardian Email
  example@example.com
- Do you want to provide Emergency Contact information that is different from the Parent/Guardian information provided above?
- EMERGENCY CONTACT INFORMATION
- Name
  
  First NameLast Name
- Phone Number
  ex. 555-555-5555Format: 000-000-0000.
- Relationship to You
- Waiver and Release of Liability
- Code of Conduct
- Signature
- Use your mouse or finger to draw your signature.
- Date
  
  MonthDayYear
  2 digit month, 2 digit day, 4 digit yearDate
- Should be Empty: