Deep River Church of Christ

Recovery Registration

Please complete all fields.  If you have any questions, please feel free to email us at
Name (First & Last)
Email Address
Mailing Address
City, Street, Zip
Home Phone
Cell Phone
Preferred method of contact: Email   Cell    Home Phone
How did you hear about us?
Are you currently: Separated   Divorced   Widow/Widower
Do you need to talk to someone immediately? Yes   No
For the classroom materials, we do ask for a $20 donation to cover the cost.  If this is a financial hardship, we offer assistance, if needed.  Assistance needed? Yes   No
We offer childcare service at no cost for ages 4-11.  Will you need childcare services while attending the event? Yes   No
If yes, how many children and what ages?
For additional information on the divorce care program, go to for an overview of our programs.
Your Questions or Comments