Circles of Support - Expression of Interest

Name *

First

Last

Email *

Phone *

1. Which Information Session and/or Circles of Support program do you wish to attend? (Tick all that apply) *

Information Session (ahead of Program 2, Thursday Evenings, Palmerston): 9 Jun 22, 6:00 to 8:00 pm
Circles of Support Program 2 (Thursday Evenings, Palmerston): 6:00 to 9:00 pm, 8 Thursdays (starting 16 June 22, ending 4 August 22)
Information Session (ahead of Program 3, Monday Evenings, Casuarina): 27 Jun 22, 5:30 to 7:30 pm
Circles of Support Program 3 (Monday Evenings, Casuarina): 5:30 pm to 8:30 pm, 8 x Mondays (starting 4 July 22, ending 22 August 2022)

2. Why are you interested in the Circles of Support program? (Tick all that apply) *

To meet other people with a loved one who experiences issues related to mental health, alcohol or drug use
To learn about mental health, alcohol and drug related misuse and co-occurring issues
To understand recovery and ways to support recovery
To learn ways to support your own wellbeing and practice self-care
To manage overwhelming emotions and responses
To learn how to identify and respond during a crisis
To learn how to respond to sigma and discrimination
To learn ways to effectively communicate your needs and rights
To learn how to set boundaries
To understand how to navigate the mental health and alcohol and other drug service system
To access support for myself

3. Please confirm the following background information: (Tick all that apply) *

I am over 18 years of age
I have a loved one who experiences an alcohol or other drug problem
I have a loved one who experiences a mental health problem
At this point in time, I can commit to attending most/all of the sessions I have indicated

4. Please confirm that you are the person named in this Expression of Interest form, or that they have provided you with consent to fill the form in on their behalf: *

I agree

Optional Comment or Message