WINTER 2015
Registration for NAMI Family to Family
March 2 – April 8 │ Mon. & Wed. evenings, 5:15 – 7:45 p.m.
Location: KTOO Conference Room
Please send in this form your registration to NAMI Juneau. You are welcome to use this form to register for a
future course if you are not available for the upcoming course listed above. After registration you will receive
pertinent information about the course.
Who is the Course Designed For?
The NAMI Family to Family course is suitable for parents, siblings, spouses, partners, teenage and adult
children, and significant others who are family caregivers of adult individuals diagnosed with Schizophrenia,
Major Depression, Bipolar Disorder, Borderline Personality Disorder, Panic Disorder, Obsessive-Compulsive
Disorder (OCD), Posttraumatic Stress Disorder (PTSD), and Co-Occurring Brain and Addictive Disorders. We
strongly encourage you to share this experience with other family caregivers to benefit from the information,
the resources, and the hopes that this course provides.
This is a course in which the highest priority is placed on protected disclosure of the participants. NAMI F2F is
offered as respite for caregivers and gives opportunity for participants to share the challenges of caring for
another living with a mental illness. This course is therefore not appropriate for individuals living with a
mental illness unless those individuals also have first degree relatives or partners who are ill, that is, they are
also family members. Individuals living with mental illness who are also parents, spouses, partners, siblings,
and adult children are welcome to take the course if their present condition is stable. Many family members
also living with mental illness are teachers and trainers in the NAMI Family to Family Course.
Because of the need to preserve a safe place for family caregivers, NAMI national has a strict policy of not
allowing researchers and behavioral health care professionals to attend unless they themselves meet the
criteria above. The only time we grant an exception is when 100% or the participants give explicit permission
at the first class to the participation of non-peer participants.
Our experience has taught us over the years that some family members are not yet ready to commit to a 12
week course for emotional reasons or timing constraints, but would greatly benefit from participating in a
NAMI support group. NAMI Juneau offers an ongoing family support group. The NAMI Family support group is
for family caregivers like NAMI Family to Family. Please consult www.namijuneau.org for current times and
locations.
What is the Commitment?
While the NAMI F2F course is free, we ask registrants to commit to the full course (not missing more than 4
sessions of the 12 offered) which takes place over twelve 2 ½ hour sessions. We are now offering the class
with two meetings per week over 6 weeks. You will receive as part of the course a free NAMI Family to Family
manual that is quite extensive and can be used as reference for the years ahead.
Who teaches NAMI Family to Family?
Our teachers are trained and certified NAMI Family to Family teachers who have undergone the 20 plus hours
of NAMI training required to teach the class. All teachers are peers, which means that they also are family
members or partners caring for a loved one living with a mental illness. NAMI and NAMI Juneau work hard to
maintain the excellence of the curriculum and the teaching. We will seek your feedback during and after the
course.
Do I need to be a member of NAMI to take the course?
No. But we hope you will join to enable NAMI Juneau to continue to offer this course for free. You can join
NAMI and NAMI Juneau in the same membership for $35 by going to www.namijuneau.org and click ‘Join’
under the Donate tab.
<REGISTRATION FORM ON NEXT PAGE>
REGISTRATION BELOW. PLEASE COMPLETE AND RETURN TO NAMI JUNEAU BY FAX, EMAIL OR MAIL:
Date: Click here to enter text.
Name(s): Click here to enter text.
Address/City/Zip: Click here to enter text.
Email:Click here to enter text. Home Phone: Click here to enter text.
Cell/Work Phone: Click here to enter text.
Are you currently a NAMI Member? ☐Yes ☐ No
Relationship to family member:
☐ Parent
☐ Spouse/Partner
☐ Child
☐ Sibling
☐ Family caregiver
☐ Other (please specify) Click here to enter text.
Age of family member: Click here to enter text.
Type of mental illness/behavioral difficulties:
☐ ADHD
☐ OCD
☐ Anxiety/Panic/Phobia
☐ Oppositional/Defiant Disorder
☐ Bipolar
☐ Schizophrenia
☐ Conduct Disorder
☐ Substance Abuse
☐ Eating Disorders
☐ Other (please specify) Click here to enter text.
☐ Major Depressive Disorder
Living arrangements of family:
☐ Lives with me
☐ Lives with another family member
☐ Lives in a treatment facility
☐ Other (please specify) Click here to enter text.
How did you hear about Family-to-Family? Please check one:
☐ Newspaper advertisement
☐ Email Blast
☐ Radio announcement
☐ Faith Community
☐ A friend
☐ Other (please describe) Click here to enter text.
☐ Provider
Do you have any dietary restrictions?
☐ Yes ☐ No
If yes, please list: Click here to enter text.
We encourage other members of your family to attend. If anyone else will be attending some or all of the
course with you, please list here: Click here to enter text.
Please share with us the reason for signing up for the NAMI Family to Family Class:
Please contact our Executive Director, Crystal Bourland at the contact info below if you have further questions.
NAMI Juneau | Jordan Square Building | 9000 Glacier Highway Suite 201| Juneau, AK 99801-8032
Email: namijuneau@gmail.com Phone 907 463-4251 Fax 907 500-9914 Website: www.namijuneau.org.