PCIS 2025 06 Registration PCIS Registration FormChildren of first responders have unique experiences as they navigate the shift work and vicarious trauma that may be experienced as a result of the career. WRF is proud to support the adult children of first responders at our second annual Post Critical Incident Seminar for the children of first responders. Participants will meet like minded people who may share in the same experiences, learn about how to navigate any possible negative impact of the career on them, while learning new skills for communication, coping, and resilience. This form is to Register for PCIS 2025 06 on June 23 - 26We 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 City and State(Required)Please select Discipline of Parent:(Required) Law Enforcement Fire Service EMS 911 / Communications Medical Examiner Spouse Fiance Significant Other Partner Agencies Parent Works/Worked For:(Required)# of Years Parent Worked as 1st Responder:(Required)Is Anyone Else in Your Family a 1st Responder?(Required)YesNoIf Yes, Who?Your Current Employment:(Required)Gender(Required)MaleFemaleRace/Ethnicity(Required)American Indian or Alaska NativeAsianBlack or African AmericanHispanic or LatinoNative Hawaiian or Other Pacific IslanderWhiteContact InformationCell Phone(Required)Home PhonePersonal Email(Required) Work Email Preferred means of communication:(Required)Preferred Name to Use on Name Tag(Required)What are the best days & times to contact you?(Required)Personal InformationRelationship 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 incident 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 you believe are a result of your parent working in the first responder field?(Required)What brings you to our seminar?(Required)How do you currently cope with stress?(Required)Do you use substances to cope with stress?(Required) Yes No If Yes, what and how often or frequency?(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 (past or present) in the Military?(Required) Yes No Branch of Service(Required)Do you consider any military experiences to have impacted you or your family's mental health?(Required) Yes No Other Mental Health InformationAre you currently engaged in therapy or counseling with a Mental Health Professional (MHP)?(Required) Yes No If you have any questions, please contact Jill Newman or Mark Calhoon at 405-285-0544 or via email: Jill@warriorsrestfoundation.org or Mark@warriorsrestfoundation.org
