Rapid Response program on Firefighter Cancer Prevention: Registration and Consent form

Please note that the course if offered in either English or French. If you would like to register for the French version, please click here. / Veuillez noter que le cours est offert en anglais ou en français. Si vous souhaitez vous inscrire à la version française, veuillez cliquer ici.

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Dear CAFC Members,

We hope you are well. Thank you for your interest in participating in the CAFC Rapid Response program in Cancer Prevention. This registration has 2 components: (a) the registration and pre-test for the program, and (b), an optional form for you to give permission for your information to be used in a research program, and provide us with additional demographic data.

Note that if you choose to participate in the research, all your data will remain secure and anonymous throughout the process. You will only be identified through a participant ID and never your name or any identifying information in any of the materials.

If you wish to register only for the program and not the research part, simply provide your information below, and leave the fields on page 2 empty before completing your submission.

If you have any questions, please don't hesitate to reach out to our Director of Operations and Membership Services, Ms. Anabel Therrien at atherrien@cafc.ca.

We look forward to seeing you at the first session!
Thank you,
CAFC

(1): Registration Form and Pre-Test

Question Title

* Please tell us who you are

First and Last Name

Title

Name of department

Street address 1

Street addess 2

City

Province

Postal Code

Question Title

* Why are you taking the course?

Request from my department

Personal Interest

Other (please specify)

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* Do you intend to complete all three modules and receive your certificate?

Yes

Question Title

* To what extent are you familiar with fine and gross decontamination?

A little familiar

Somewhat familiar

Very familiar

Question Title

* To what extent do you believe there are barriers to decontamination practices?

Not at all

Somewhat

A lot

Question Title

* Do you believe that we can overcome these barriers and improve decontamination practices?

Yes

Question Title

* What do you hope to achieve by taking this course?(Max 2 sentences)

Question Title

* What is the biggest issue that you are facing when it comes to cancer prevention in your fire department?

Click on the submit button below to move on to the optional consent form and demographic questionnaire