Support Group Interest & Pledge of Confidentiality
Name or Client Id
I am interested in the following peer support groups. Please check all that apply.
S.E.L.F. - Peer Support Gay & Bi-Sexual Men - 7 PM Mondays
YMSM Support Spot - HIV + Men 18-28 years old.
Positive Support - Co-Ed 1st & 3rd Wednesdays 6:30 PM
Double Jeopardy - HIV &... Hep or Substance Issues 6 PM - HIATUS
Positive Women - Ladies Group 1st & 3rd Fridays 7 PM
Latino Support Group - Miercoles 1pm to 2pm
Non-HIV Specific Support Group
Transgender Support Group (Volunteer Facilitators are Needed)
African American Support Group (Volunteer Facilitators are Needed)
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.
I agree to comply with the above.
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 comply with the above
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
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service