PUBLIC SAFETY ALLIANCE REGISTRATION FORM FOR:
MENTAL HEALTH & DE-ESCALATION FOR LOVELACE HOSPITAL
Wednesday, October 14 - Thursday, October 15, 2020
0800 - 1700
Location: TBD
Directions: Albuquerque, NM

Prerequisite: None.

Course Description: Our two-day course, develops an understanding of the multitude of mental illness categories from the National Alliance on Mental Illness, and places them into four response categories. This
training easily allows students to employ the lessons learned here, into your agency's already established policies. This is a course NO ONE can miss!

As our student, you are trained to appropriately identify cues of mental illness and introduce risk reduction methods to diffuse an often tense, or deadly situation. New techniques and considerations are learned when you enter the world of Post-Traumatic Stress Disorder and regarding response to trained combatants. You will also fine-tune your responses to alcohol or drug induced psychosis, and understand the "personal crisis" of suicide and suicide-by-cop. Other special modules include: OIS with the Mentally Ill, Managing the Madness, Mental Illness in Schools, and The Winning Scenario. This tiered training concludes with over four hours of student participation during active-scene scenarios, where your responses are tested and refined. You are also provided with categorized Active-Listening responses, positive Reflecting/Mirroring postures, Encouragers and Diffusing Drills.

Dress Code: Uniform, business casual, or the uniform of the day.

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, please contact:
Program Manager, Nick Ramos at nickramos@trainPSA.org or (505) 573-9672.
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)

E-mail: *

Alternate E-mail Address:

TRAINING COORDINATOR / SUPERVISOR
Full Name

Phone:  (e.g. ###-###-#### - ext) 

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

 

I AGREE TO THE FOLLOWING HOLD HARMLESS RELEASE AGREEMENT

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 understand that Public Safety Alliance reserves the right to cancel or reschedule the course with no prior notification to students. Submitted registrations will be returned to the payee in full.
  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