NAMI Warren County, NJ Support Groups
***Disclosure*** NAMI Warren County's intention is to protect personal information.  We will not use this information beyond registration and immediate safety purposes.

Please note, NAMI Warren County, NJ will be using the platform-Zoom when online.

In order to protect confidentiality during the group please read the following:

1. Please identify if anyone else can hear the conversation when online.
2. When online, Zoom and the host facilitator, may collect some basic information as to where calls originate,  such as IP address, etc.
3. Online sessions and in person sessions will not be recorded.  Please do not take screenshots, take pictures or take notes with personal information.

Please register 2 days before the support group is scheduled.  You will receive a reminder email to the support group including a Zoom link (on-line) or the address of the in-person site by the morning of the scheduled group providing this form is completed by you.
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Your email address *
Your First Name *
Your Last Name *
What State & County do you reside? *
Who in your family has a mental health condition? (Check all that apply) *
Required
Address   *
We are requesting the address where you will physically be while attending the support group so that we can send emergency services to you, if you are in immediate physical harm or have a medical emergency.  In a mental health emergency, we will make every effort to contact your emergency contact before calling 911.  This information will not be shared and will be deleted after each support group.  This information will not be used for any other purpose.
Phone number *
We are requesting your personal phone number so that we can reach you if you are experiencing a mental health emergency and we need to contact you outside of the group to connect you with crisis services and/or your support system.  We will also use this phone number to reach you, if you are experiencing a mental health emergency and log off.  This information will not be shared and will be deleted after each support group.  This information will not be used for any other purpose.
Emergency Contact Name
We are requesting the name of your emergency contact in case you experience a health emergency during the support group.  In the case of an emergency, we will contact your emergency contact so that we can link you to crisis services and/or your support system.  This information will not be shared and will be deleted after each support group.  This information will not be used for any other purpose.
Emergency Contact Phone Number
We are requesting your emergency contact's phone number in case you experience a health emergency during the support group.  In the case of an emergency, we will contact your emergency contact so that we can link you to crisis services and/or your support system.  This information will not be shared and will be deleted after each support group.  This information will not be used for any other purpose.
Have you attended any of NAMI NJ's online support groups? *
Are you a first time participant in NAMI support groups? *
Are you a veteran? *
Thank you for completing this form.  All information will be held in confidence.  You will receive a link via email by the morning of the scheduled support group.  Thank you for your interest in attending the support group! Please select "SUBMIT" below to submit your information.  Thank You!
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