Jesus Mends The Pieces - Registration

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Welcome

Thank you for your interest in Jesus Mends The Pieces, a 6-week Christ-centered support group for women healing from domestic violence, led by Lydia Stroud.

This group provides a safe, supportive community where women can find healing, encouragement, practical tools, and hope through Christ.

Group Details

Dates: Mondays beginning October 5
Time: 5:30 PM – 7:00 PM
Location: The Oaks Community Room
4558 Pleasant Garden Rd.
Greensboro, NC 27406

Please note: A brief screening conversation is required before joining the group to help ensure the group is a safe and supportive fit for everyone.

If you are in immediate danger, please call 911. The National Domestic Violence Hotline is available 24/7 at 800-799-7233 or visit thehotline.org.

Email *

Record my email address with my response

Full Name *

Phone Number *

Preferred Method of Contact *

Phone

Text Message

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Age

How did you hear about this group?

The Oaks Website

Social Media

Friend or Family Member

Church

Counselor/Therapist

Community Organization

Google Search

Other

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Are you able to attend most Monday evenings from 5:30 -7:00pm for the six-week group? *

Yes

I may miss one or two sessions

I'm unsure

Are you currently living with an abusive partner?
*

Yes

If applicable, how long has it been since you left an abusive relationship?

Do you have a safe way to attend weekly group sessions without risk?
*

Yes

A brief screening conversation is required before joining the group.
*

I understand that a member of The Oaks team will contact me to schedule a brief screening conversation.

Required

Is it safe for us to leave you a voicemail?
*

Yes

Is it safe for us to send you a text message?
*

Yes

Is it safe for us to send you an email?
*

Yes

Is there anything you would like us to know before we contact you?

Please check each statement below.
*

I understand this is a support group and is not a substitute for individual therapy or emergency services.

I understand that information shared by participants is expected to remain confidential.

I understand that completing this registration does not guarantee placement in the group and that participation is determined after the screening conversation.

I understand that if I am in immediate danger, I should call 911 or the National Domestic Violence Hotline (800-799-7233).

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