PUBLIC SAFETY ALLIANCE REGISTRATION FORM FOR:
POLICING THE MENTALLY ILL: THE AUTISM ANGLE
Thursday, October 5, 2023
0800 - 1700
Location: HIDTA Training Center, Garden Level
Directions: 5700 S. Eastern Ave., Commerce, CA 90040

A ONE-OF-A-KIND SPECIAL PRESENTATION!



Prerequisite: Students must be full or part-time Law Enforcement, Probation/Parole, Corrections/Jail, Fire, EMS or Security personnel or work under the umbrella of an agency. If you have questions regarding your qualifications, please contact us at training@trainPSA.org.

Course Description: This 8-hour, open format, course covers everything Autism for first responders. As Public service officers are forced to deal with more individuals with mental health diagnosis, those with Autism are rising to the top. This specialized course helps students understand Autistic behavior, realize communication capabilities and learn restraint from the pitfalls of Autistic anger. This course also explains The Americans with Disabilities Act and what it means for you! Personal experience and examples of Developmental Disability drives the creativity and lively presentation you can't miss.                                                           

Who Should Attend: Law Enforcement, Probation/Parole, Corrections/Jail, Fire, EMS and Security personnel

Instructor: Your Instructor, Michael Coleman, (ADAC), is a 17 year veteran police officer who has focused his career around Autism and training others. He is nationally renound and consistently provides guidance during the American With Disabilities National Conference and other federal, state, and local institutions. His witty personality and playful bantor turns an otherwise dry classroom into a fun and eventful experience. Michael is certified as an ADA Coordinator, CIT Coordinator, NvLend Graduate, TAC-MED instructor, FTEP Coordinator, and serves as a member of his agency's Crisis Negotiator Team.                                                                                                                                                                                                                                                                   

Dress Code: Comfortable clothing and closed toed shoes are recommended.

Lodging and Meals: Students are responsible for their own hotel and meals.

Contacts: If you are running late to the course or have other problems or questions regarding this course, please contact:
Program Manager,
Nick Ramos at: nickramos@trainPSA.org or (505) 573-9672
PSA office, at: info@trainPSA.org

APPLICANT INFORMATION *required 
Name will appear on certificate of completion
First Name: *

Last Name: *

Position/Title/Rank: *

Agency/Organization Name: *

State (2 characters e.g. TX): *

COMMENTS
Provide any specific information regarding registration
 

  

CONTACT INFORMATION
(for registration purposes only)
Phone Work: (include area code) *
Mobile Phone: (include area code)

Student E-mail: *

Alternate E-mail Address:*

TRAINING COORDINATOR / SUPERVISOR
Full Name

Phone: 

Training Coordinator Email Address: (if applicable)
(Will receive copy of confirmation)

AFFILIATION INFORMATION*
Staff from an STC participating agency may attend this event at a
contracted rate. Please contact PSA to inquire about contracting options.

 I am NOT an STC Member - $150

 I am from an STC participating agency
        PSA Association number IF assigned: 
 Note: NOT ALL AGENCIES ARE ASSIGNED AN  
ASSOCIATION NUMBER.

TOTAL COST

  


Method of Payment:
 Check / Pay at Door    Credit / Debit Card

Credit / Debit Card Information (all fields required)
Card Type

Cardholder's First Name

Cardholder's Last Name

Credit Card Number

Exp Date
(e.g.: 05/2024)
Security Code

 

Cardholder's Billing Street Address

Billing City

Billing State
(2-character state code)
Billing Zip Code

Billing Country
(2-character country code)
I AM THE PERSON ABOVE AND AGREE TO THE FOLLOWING:

I know that participation in some of the Public Safety Alliance projects can be potentially hazardous and I agree that my participation in this activity is entirely voluntary. I know I should not enter this activity unless I am medically able to participate and completing this PSA process attests that I am medically fit to participate.

  1. I fully recognize and appreciate the dangers and hazards inherent in the activity, which I have had a full opportunity to investigate through any questions I wished to ask of the responsible person(s). I agree to assume all the risks and responsibilities arising out of my participation in the activity and any other activities undertaken as an adjunct thereto.
  2. That in consideration of my participation in this activity, I hereby waive, release and forever discharge and agree to indemnify and hold harmless Public Safety Alliance and its trustees, officers, employees and agents, of and from any and all action, causes of action, suits, damages, claims and demands whatsoever, which the undersigned, may not have or may acquire arising from or in any way relating to the undersigned’s participation in the aforementioned event/activity.
  3. I recognize and understand that Public Safety Alliance does not provide any Accident or Medical Insurance.
  4. I have obtained the age of 18 and am legally competent to understand this document and agree to this release as my own free act.
  5. I hereby consent to any publicity, including the use of my name and likeness, in connection with my participation in this activity for Public Safety Alliance publications.
  6. I acknowledge that Public Safety Alliance may cancel or reschedule this course without prior notification or approval.
  7. I have read and understand the terms of this Release and agree to all terms and conditions.
Your email provider MAY block any sender who is not in your address book/contact list. In order to ensure you receive your certificates, course materiel and course notifications add these addresses BEFORE registering: NickRamos@trainPSA.org; Info@trainPSA.org; Training@trainPSA.org