NAMI Basics Summer 25 Registration Form
Hi, thank you for your interest in taking time to educate yourself on mental health as the parent or caretaker of a child (22 or younger) living with mental illness! Below are a few questions to get you signed up for our class on Tuesdays running June 3rd to July 15th, (no class on June 24th) from 6 p.m. to 8:30 p.m. at the Hellam Township Building. (35 Walnut Springs Rd, York, PA 17406) If you have any questions or concerns, please reach out to carter.stokes@namiyorkadams.org. We look forward to seeing you!
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
I am the parent/guardian or caretaker of a youth under 22.
*
Yes
No
The youth that I am the caretaker/parent of has a mental health condition
*
Yes
No
What is your preferred method of contact?
*
Phone call
E-mail
Text message
How did you hear about this class?
*
E-Mail
Social Media
NAMIYA Website
Physical Flyer
Billboard
Mail
From a friend/word of mouth
Through a school
Other
Submit
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