New Member Form (Adult)
We're sorry for what brings you in, but we're glad you are here
All this information is confidential and will not be shared with outside parties without your consent.
This form must be completed by the person interested in being contacted by The Christi Center.

New Members: we ask that you arrive into the Zoom Group 30 minutes before the start of group to complete an orientation to group. 
Email address *
First Name *
Last Name *
Preferred Name (Goes By):
Date of birth *
Pronouns *
Address *
Street, City, State, Zip Code, County
Phone Number *
Emergency Contact Information *
Name of emergency contact, relationship to you
Emergency Contact Phone Number *
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