Registration 2 — First Responder

First Responders — let's finalize your registration.

Step 1 of 3: Tell us about yourself.

Step 1 of 2: Tell us about yourself

Your answers help us understand where you're coming from before our call together. When you're done, we'll take you to schedule your call with Mike.

Full Name

Phone Number

Provide a brief overview of your area of community service as a first responder (e.g., Police, Fire, Rescue/Paramedic). How long have you served as a First Responder?

Provide a brief overview of what you feel has had a negative impact on your life beginning with childhood, time as a First Responder, and in your private life outside of the uniform

How do you consider the condition of your emotional health to be at this time? (e.g., depressed, anxious, isolated, no hope, etc.)

What other First Responder sponsored or faith-based programs have you attended? Did they provide you with the desired result?

Are you currently seeking or receiving mental health counseling?

Yes

How much notice would you need in order to attend one of our 5-day programs? (e.g., 2 weeks, 1 month, etc.)

Hot Fill List: Sometimes a registered attendee cancels with little notice, opening a Drop Zone seat for someone who can attend on just a few days' notice. Would you like to be considered for our Hot Fill list?

Yes

First Responders — let's finalize your registration.

Step 1 of 3: Tell us about yourself.

Step 1 of 2: Tell us about yourself

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