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On September 10th, World Suicide Prevention Day, Mindful ISTDP is providing free suicide prevention programming to the community. The schedule is listed below. Please register for your session at this form, and email questions to our Program Coordinator, Reid Depowski-Knowles, LMSW at programs@mindfulistdp.com

9am-11am: Fundamentals of Treating Suicide Risk for Clinicians. This training is designed for psychotherapists, physicians, nurses, PAs, and other healthcare providers.

1pm-3pm: Fundamentals of Responding to Suicide Risk for Helping Professionals. This training is designed for professions such as first responders, educators, HR, and others.

5pm-6pm: Talk Saves Lives: An Introduction to Suicide Prevention is a presentation for the community that covers the general scope of suicide, the research on prevention, and what people can do to fight suicide. This program will be presented by the Michigan Chapter of the American Foundation for Suicide Prevention.

Location:
Brighton Light House in Brighton, Michigan.

The clinical course through Mindful ISTDP is approved by the NASW-Michigan Social Work Continuing Education Collaborative. 2 free CE credits will be provided for this training.

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* 1. Contact Information

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* 2. Please select the program you will be attending:

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* 3. How did you hear about this event?

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* 4. Waiver of Liability

I, as a participant in this program, hereby assume all of the risks of participating in this event. I have agreed to execute this Waiver and Release of Liability Form for myself and acknowledge, agree to, and represent the following:

I understand that I am attending this event hosted by Mindful ISTDP, LLC in order to obtain knowledge, strategies, and techniques to address mental health.

I hereby release, waive, acquit and forever discharge Leslie Auld and Mindful ISTDP, LLC, as well as any employees, volunteers, instructors, representatives, agents, the event holders, event sponsors, and event volunteers (“Releasees”) from every claim, suit action, demand, or right to compensation for damages claimed or that I may have arising out of my own acts or omissions as a result of any advice given or otherwise resulting from my participation in this event. I further declare and represent that no promise, inducement, or agreement has been made other than what is expressed within this agreement.

I further waive and release Releasees from any liability incurred based on or resulting from the implementation of any information obtained at this event.

I indemnify and hold harmless Leslie Auld and Mindful ISTDP, LLC, as well as any other entities or persons mentioned above, from any and all liabilities, claims, demands, or actions made as a result of participation in this event, whether caused by the negligence of release or otherwise. I further indemnify and agree to hold harmless the aforementioned entities from any and all third party claims associated with my participation.

I understand that at this activity or event, I may be photographed. I agree, irrevocably and without restriction, to allow my photo, video, or film likeness to be used for advertising and/or any other purpose by Mindful ISTDP, LLC, as well as the event holders, producers, sponsors, and organizers. I also grant the aforementioned entities or persons the right to alter and copyright the same without restriction.

I recognize that this Waiver and Release of Liability Form shall be construed broadly to provide a release and waiver to the maximum extent permissible under applicable law.

I certify that I have read this document and I fully understand its content. I am aware that this is a release of liability and a contract, and I sign it freely, voluntarily, and competently.

Please sign below:

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* 5. Today's Date:

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* 6. Please share accommodations you need to attend our event:

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