Support Group Interest & Pledge of Confidentiality
Name or Client Id *
Your answer
I am interested in the following peer support groups. Please check all that apply.
I understand that Buddies of NJ, Inc. holds each persons' right to share confidential information in a place that is safe with utmost importance. I, hereby agree to keep confidential any and all information learned about others in support groups and/or in associating with others met through these groups. *
Safe Space & Bully Free Zone - Buddies of NJ seeks to be a safe place for people who want improve their lives regardless of status, gender, ethnicity, race, sexuality, religion, identity, or way of life. I hereby agree to respect and withhold judgmental comments and behavior toward any person who participates in peer support groups. *
I agree to let the Support Group Coordinator contact me by: *
My Signature Is Provided by the Following:
Please provide at least 2 of the following:
Phone Number, Email Address, Mailing Address *
Your answer
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