KeepOlim's Online Support Groups - Participants Form
KeepOlim (RA 580613610) under the direction of Volunteer Mental Health Director,
Dr. Robert Lubin will be starting Free Online Support Groups to help our Olim during the current crisis!

Groups will be limited in size to 6 Olim plus an experienced Oleh therapist.

Groups will be in the following languages: English, Russian, French, Spanish & Portuguese.

Each group will have 4 Free Online Sessions, after which you will have the tools to support each other in the group.

These groups are ONLY for discussion of problems related to the crisis including stress, anxiety, alienation, loneliness, finances, career and life issues during this crisis.

If you are deeply depressed or suicidal,or suffer from an addiction (or have any diagnosed psychiatric issue precluding you from participating in a time-specific/Coronavirus Support Group) then these groups are not for you. In this case you may contact us privately and we will try to find you a personal therapist.

Please fill out the form!
Your name: *
Your address: *
Your phone number: *
Your email address: *
Your country of origin: *
Your age: *
Your Teudat Zeut number: *
Your gender: *
Your marital status: *
Your occupation: *
Languages spoken: *
Are you comfortable in group discussions? *
What are the issues that make you register for the group therapy? Describe your feelings (e.g., lonely, scared, abandoned, helpless, in panic)
What do you hope to achieve by participating in the group? *
Participant Agreement and Legal Waiver for KeepOlim's Online Support Groups
By registering for KeepOlim’s Online Support Groups, you hereby declare that you are of sound body and mind that you are not suicidal in thoughts, (or have any diagnosed psychiatric issue precluding you from participating in a time-specific/Coronavirus Support Group) .
Our groups are designed to open blockages in your lives and to create new possibilities during this Corona crisis.
During the program, participants will be exposed to personal information and life stories of others participants. What is shared in groups stays in groups.

Passing confidential and personal information about other participants which may come to your knowledge (names, addresses, phones numbers and personal stories) is prohibited.

As a member of this group, I agree to not disclose to anyone outside the group any information that may help to identify another group member. This includes, but is not limited to, names, physical descriptions, biological information, and specifics to the content of interactions with other group members. It is illegal to record in any way shape or form the group sessions.

Anyone that use that info in any way (giving out information to third parties, any way of harassment, etc.) will be sued by our legal team.

You also acknowledge that KeepOlim is not and will not be responsible for the actions of the volunteers and therapists, and accordingly will not bear responsibility for any kind of damage, accidents, injuries and even personal property throughout the program - KeepOlim Onlne Support Groups.

Information that is revealed by the participants during sessions will be confidential except under certain situations such as, threatening to harm yourself or another individual or suspicion of harming yourself or another. In that case, it is the therapist’s responsibility to notify KeepOlim and or alternate authorities in order to protect the participants.

Finally, you agree that information provided by you will be stored in an internal database used for administering volunteer activity, and you acknowledge that this information may be use in a general and unidentified manner for statistical purposes only.

You acknowledge that you are in the Support Group at the discretion of KeepOlim and its volunteers. And you acknowledge that there can be situations where for the benefit of yourselves or the group you may be ask to leave group.
Do you agree with the aforementioned rules and conditions? *
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