Suicide Prevention Training

SUICIDE PREVENTION TRAINING

Registration is required for every adult.

As part of Mental Health Awareness Month, we invite you to participate in QPR Suicide Prevention Training—a 90-minute, evidence-based, life-saving intervention designed for individuals aged 16 and older. This important training is open to both YMCA members and non-members.
Is the attendee 18 years of age or older?
GUEST INFORMATION
Guest Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth

MonthDayYear
Email
example@example.com
Member Status

Other
- Parent/Guardian Name
  
  First NameLast Name
- Relationship to Minor
- Date of Birth
  
  MonthDayYear
- 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
- Please Select One Training You Will Attend:
- Waiver and Release of Liability
- Code of Conduct
- Signature
  
  Clear
- Use your mouse or finger to draw your signature.
- Date
  
  MonthDayYear
  Date
Should be Empty: