Program #1

Domestic Violence

Faith-based group support — free, confidential, and open to all.

Join This Program

Fill out the form below and we will contact you to confirm your spot. All information is kept strictly confidential.

First Name

Last Name

Phone

Preferred Contact Method

Who is this registration for?

Are you currently in a safe location?

Yes No — I need help now

If you are in immediate danger, please call 911 or the National DV Hotline: 1-800-799-7233.

Would you like someone to contact you before your first session?

Yes, please call/text me No, I'll attend and see

Anything you'd like to share (optional — confidential)

Your information is kept private and will never be shared. Heart to Hope Center is a 501(c)(3) charitable organization.