host-medical-roster - Human Empowerment and Leadership Principles

Host: Medical Health Registration

Please fill out the form below with all of your Roster information. We will contact you shortly afterwards.

You may request an Invoice after Roster submission.

Roster-Host: Medical Health Form

CAPS requires a minimum of 6 participants in order to claim the 'Group' workshop status.

If you would like to sign up between 4 and 5 participants, please fill out one Guest form for each participant.

Our Behavioral Health Guest Form can be found HERE

Training Coordinator Information

Please fill your (training coordinator's) information here.

First Name

Last Name

Organization you are employed with:

Your Job Title:

Phone/Mobile

Organization Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Date of the workshop:

Location of the workshop:

Is your organization currently using any Safety Management Protocols?

Yes

If "Yes", which one:

Please fill out your workshop participant roster and choose the Certification each participant is seeking.

This is for participant's information only.

First Name

Last Name

Choose Certification Seeking

First Name

Last Name

Email 2

Choose Certification Seeking

First Name

Last Name

Email 3

Choose Certification Seeking

First Name

Last Name

Email 4

Choose Certification Seeking

First Name

Last Name

Email 5

Choose Certification Seeking

First Name

Last Name

Email 6

Choose Certification Seeking

First Name

Last Name

Email 7

Choose Certification Seeking

First Name

Last Name

Email 8

Choose Certification Seeking

First Name

Last Name

Email 9

Choose Certification Seeking

First Name

Last Name

Email 10

Choose Certification Seeking

First Name

Last Name

Email 11

Choose Certification Seeking

First Name

Last Name

Email 12

Choose Certification Seeking

First Name

Last Name

Email 13

Choose Certification Seeking

First Name

Last Name

Email 14

Choose Certification Seeking

First Name

Last Name

Email 15

Choose Certification Seeking

First Name

Last Name

Email 16

Choose Certification Seeking

First Name

Last Name

Email 17

Choose Certification Seeking

First Name

Last Name

Email 18

Choose Certification Seeking

Please review these terms: I understand this form must be completed and submitted online in order to participate in CAPS programs and training. I also understand that Crisis Assessment & Prevention Systems will provide the training and support necessary to ensure that all participants obtain the skills necessary to prevent and manage aggressive behavior.

Review the Workshop Guidelines linked below. By submitting this form you are agreeing to rules set out in the Workshop Guidelines and that you have read all of the Guidelines.

Workshop Guidelines

	E	A	NI
Cleanliness
Comfort
Climate
Suitability to training

	E	A	NI
Knowledge of material
Attitude
Rapport with trainees

	E	A	NI
Appropriateness to job
Easily understood
Format

Host: Medical Health Registration

CAPS requires a minimum of 6 participants in order to claim the 'Group' workshop status.

Training Coordinator Information

Please fill out your workshop participant roster and choose the Certification each participant is seeking.

HELP is not a "crisis intervention" program.

Services

Contact

HELP Training Evaluation

Please choose your rating of HELP Training for each category.

Training Area

Trainer

Material

Which three sections did you find most helpful?

Order HELP Standard or Communication Certification Cards

Delivered by Mail

Please provide the shipping address where you would like to receive the cards.

Order HELP Standard or Communication Certification Cards

Delivered quickly through Email

Please list the name of all card recipients and their email addresses below.