Thursday, November 27th, 2025

Free Indeed

Recovery and Marriage Program Registration Form

First and Last Name

what is the reason for you attending our classes?

Best cell Phone to call or text?

Can we text this phone?

Yes

Full Mailing Address to send mail to (not required if homeless or secret)

Are you currently attending another church?

Yes

Name of Church you regularly go to (if not, N/A)

Is this a required course per court order?

Yes

If you have a parole officer associated with this, please provide their contact information here:

Are you currently in any other Recovery Program?

Yes

If you are attending another program, please let us know which one(s):

Is there anything specific you would like us to pray for you about?

Our classes are Fridays at 11am-2pm starting August 14th 2026, and 3pm-5pm for marriage therapy classes. Which date and time you will start attending our classes?

Month

Day

Year

Time

:HoursMinutes

I am aware that Eagle River Baptist Church will not share my information to any third party, and it is only going to be used for the purposes of this program and church related matters, and not to solicit money. x________Signature

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Email: Click Here!

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