Community of Peer Empowerment (COPE) is a support group for youth and young adults ages 15-19. Registration is required for this group and must be done by a parent or guardian for youth under 18 years old.

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* 1. Participant's Full Name

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* 2. Participant's Phone Number

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* 3. Participant's Email Address

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* 4. Participant's Age

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* 5. Participant's Grade

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* 6. Parent/Guardian's Full Name

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* 7. Relationship to Participant

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* 8. Parent / Guardian's Phone Number

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* 9. Parent / Guardian's Email Address

NAMI programs are designed to provide individuals and families who are affected by mental health issues with a deeper understanding of mental health and strategies for living in a healthy and positive way. NAMI programs should not be used to replace the specialized training and judgement of mental health professionals. The COPE teen support program is not meant to replace therapy. It is a mental health promotion program meant to help teens know that they are not alone and to allow them to find peer support and learn from others who are going through similar circumstances.

I have read and I understand the above statement.

Parent/Guardian: Please initial below.

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* 10. Parent / Guardian Initial

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