NAMI Camden County June 2024 ONLINE ONLY Connection Support Group Registration
Tuesday June 4, 2024 7 - 8:30 pm
This group is a recovery support group for adults living with mental health issues.

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

In order to protect confidentiality during the group please read the following:
1. Please identify if anyone else can hear the conversation.
2. Remember that Zoom and the call host, may collect some basic information as to where
calls originate, IP address, etc.
3. Calls will not be recorded. Please do not take screenshots, or take notes with personal
information.

Please register by 12 pm on the day of the support group.  The Zoom link will be sent by 5 PM that
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Email Address (Where you want the meeting link to be sent) *
First Name *
Last Name *
Street Address             *
We are requesting the address where you will physically be while attending the program 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 program offering. This will not be used for any other purpose.
City/Town *
Zip *
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 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 program offering. This will not be used for any other purpose.
Emergency Contact Name *
We are requesting emergency contact information in case you experience a health emergency during the program. 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 program offering. This will not be used for any other purpose.
Emergency Contact Phone Number *
We are requesting emergency contact information in case you experience a health emergency during the program. 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 program offering. This will not be used for any other purpose.
Is this your first Family Support Group? *
Required
How did you hear about our local Affiliate Group? *
Are you a Veteran? *
Required
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