Serenity Training/Course Registration
Participant Registration and Participation Informed Consent Form
Training/Course Title
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Training/Course Date
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Month
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Day
Year
Today's Date
Name:
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First Name
Last Name
Are you attending this training/course in person, or remotely?
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Select One
In Person
Remotely
Select one
Participation Informed Consent
The Training Agenda and handouts will be provided in advance of the training. Do you understand the objectives of the training?
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Yes
No
Are you aware that the content of this training and professional examples provided in this training, and as listed in the training agenda, may be triggering and cause personal distress?
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Yes
No
Do you understand that you have the right to leave this training at any time without repercussions or it being addressed for the purpose of self-care?
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Yes
No
Do you understand that you have the right to not participate in role-plays or discussions that may cause personal distress or general feelings of discomfort without repercussion, or it being addressed?
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Yes
No
Do you understand that you have the right to decline answering or commenting on any questions that cause you general distress or discomfort?
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Yes
No
Do you agree to complete the post training survey by the end of the workday?
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Yes
No
Register and acknowledge consent with your signature:
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Submit
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