PCIS 2024 11 - A Registration - For Adult Children of First Responders (ages 18 & up) This form is to Register for PCIS 2024 11 - A on November 15-16, 2024 This Event is intended to be for Adult Children of First Responders (ages 18 & up)The PCIS will concentrate on helping our participants normalize the trauma reactions that families may go through due to the First Responder Stress Spillover. Participants will work with experienced peers who are also children of First Responders. Participants will learn to increase personal resilience and communicate effectively with others sharing similar experiences. We recommend no weapons be worn during the seminar. Please secure your weapons in your vehicles or rooms. An armed police officer will be on sight.(Required) I agreeParticipant Name(Required) First Last Discipline of Parent:(Required) Fire EMS Police Corrections Communications Agencies parent works/worked at:(Required)Your Current Employement(Required)Is anyone else in your family a First Responder? If yes, who?(Required)Contact InformationWork Cell(Required)Personal Cell(Required)Home Phone(Required)Work Email(Required) Personal Email(Required) Preferred means of communication:(Required)Preferred Name to Use on Name Tag(Required)What are the best days & times to contact you?(Required)Relationship Status(Required)MarriedEngagedSignificant OtherSingleOtherHealth and Emergency InformationPlease list any health and/or mobility concerns:(Required)Please list any food allergies:(Required)Please list any other allergies of concern (i.e. Poison Ivy / Poison Oak / Dogs / etc.): *(Required)Emergency Contact(Required)Mobile Phone for Emergency Contact Person:(Required)Incident and/or Trauma InformationPlease describe any critical incidents that your parent was involved in that may have impacted you and the age you were when it occurred(Required)For example: shooting; serious child abuse; line of duty loss of a friend or coworker, etc.; Specific details will provide us with better information on how your critical incident(s) may have impacted you and to help us ensure we have appropriate staff available.Are you aware of any reactions in yourself that you believe are a result of your parent working in the first responder field?(Required)What brings you to our seminar?(Required)All participants should be aware that alcohol and substance abuse is not allowed at the PCIS.What is the outcome that you would like to achieve post seminar(Required)Military ServiceHave you or your parents served in the military(Required) Yes No If yes, what branch?Other Mental Health InformationAre you currently engaged in therapy or counseling with a Mental Health Professional (MHP)?(Required) Yes No
