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San Benito+ Youth Zoom Hangout
The purpose of this group form is to ensure community members are able to attend the San Benito+ Virtual Support Group and get the link to join the group. Participation in The San Benito+ Virtual Support  Group requires you to follow safe space guidelines linked below. All information submitted on this form will be kept confidential.

Once you fill out this Google Form, a San Benito County Behavioral Health staff member will follow up with you regarding the unique zoom access link for the group. The zoom access link is unique to that specific support group DATE. The link will not work outside of the scheduled meeting time.

We respect your privacy and understand not everyone may feel comfortable entering personal information on-line. You can receive access to The San Benito+ Virtual Group by contacting Daniel Padron at (831) 636-4020  and leaving a message.  Please indicate on your message if discretion needs to be used when returning your call.

Requests to The San Benito+ virtual support group should be made 24 hrs before the day and start time of the group.

Thank you,
San Benito County Behavioral Health  
E-mail address *
 First and Last name *
Phone Number *
Age *
I hereby agree that I have read and will abide by the San Benito+ Virtual Support Group Guidelines. Group guidelines can be found here: https://docs.google.com/document/d/1l5SxbIaMuj3__EyjjO8vNkjQvdy_Rh7wCK48su0LiLU/edit * *
Sponsored by San Benito County Behavioral Health
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