NAMI BASICS Online Class-Attendee Registration

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Please complete this registration if you would like to attend NAMI CAMDEN COUNTY / NAMI NJ's BASICS six week course on Thursdays, May 5, 2022 to June 9, 2022, 6:45 to 9:15 pm.

NAMI BASICS s a free education course for PARENTS and OTHER FAMILY CAREGIVERS of children and adolescents living with mental illness. This course includes an overview of the diagnostic process: types and subtypes of major mental illnesses that can develop in childhood and adolescence: ADHD, Oppositional Defiant Disorder, Compulsive Disorder, Anxiety Disorders, Mood Disorder, Depressive Disorders, Bipolar Disorder, Schizophrenia, Obsessive Compulsive Disorder and Substance Use Disorders. This course is taught by trained teachers who are also parents/ caregivers of individuals who developed the symptoms of mental illness prior to the age of 13 years.

Email *

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip *

What address would you like your manual mailed to? *

Same as above

Other:

Required

Home Phone

Cell Phone *

First contact preference *

Home phone

Cell phone

Emergency Contact Name (we only require this for an extreme health emergency. this information will not be shared or saved) *

Emergency Contact Phone Number *

Emergency Contact Relationship *

What local NAMI affiliate, Statewide program, or multicultural program are you a part of? If none, write N/A *

How did you hear about the class? *

NAMI support group

NAMI e-newsletter

Newspaper

Social media

Family/friend

Other:

The person with the mental health condition is your: *

Son/daughter

Foster child

Grandchild

Other:

The person lives:

with me

with another family member

in a treatment facility

Other:

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Do you know what your loved one's diagnosis is? *

Yes

Not Sure

What is the age of your loved one? *

Type of mental health conditions / behavioral difficulties *

ADHD

Anxiety / panic/phobia

Autism spectrum disorder

Bipolar disorder

Conduct disorder

eating disorder

major depressive disorder

OCD

Oppositional/defiant disorder

Schizophrenia

Substance abuse

Don't know

Other:

Required

If so, are you comfortable using Zoom? *

Yes

I have never used Zoom before

Do you have a webcam (connected operational camera) and microphone (installed or headset mic) on your desktop, laptop, or tablet? *

Yes

Not sure

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A copy of your responses will be emailed to the address you provided.

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