DivorceCare Registration

  • Please enter an e-mail address if you have one. We will use this as a main form of communication with you. We promise your e-mail address will not be sold or shared with anybody. If you do not have e-mail then we will communicate directly with you via your phone number.
  • Please enter your primary phone at which you can be contacted.
  • Please enter an alternate contact phone number for you. It could be your home, cell or work number.
  • Enter the name of the person to be contacted in the case of an emergency.
  • Enter the phone number for the person you've listed as your emergency contact.
  • Enter the name of your primary care physician.
  • Enter the phone number of your physician.
  • Enter the name of your home church and your Pastor's name if you have one. If you don't have one just enter "None."
  • This is required so we can plan accordingly for your children to attend. Thanks.