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

Please note, NAMI NJ will be using the platform-Zoom

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 11 a.m. ET on the day of the support group. You will receive a link via email the morning of the scheduled group.

Sign in to Google to save your progress. Learn more
Email *
First Name *
County/Affiliate/Multicultural Program *
Can we provide your contact information to a NAMI local affiliate near you or multicultural program for additional support services? *
Zip Code *
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.
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.
NAMI Connection Recovery Support Group is a 60-90 minute support group for adults (18+) with a mental health condition. Participants gain the support of peers who understand their experience and gain insight into others’ challenges and successes. *
Are you a first time participant in NAMI support groups? *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of NAMI NJ.

Does this form look suspicious? Report