Contact information for RCHC Online Classes
Hi! We're so excited you'd like to be involved with us online, before we get started we just need some general information from you. *NOTE: if you are already a member in-person please disregard, you do not have to fill out this form. This form is for non-members only.

We collect this information to ensure the safety of our members and staff. If you have any additional questions please feel free to call us: 513-241-1411. All of our classes can be found here: recoverycenterhc.org 
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First & Last Name *
Date of Birth *
Phone number *
Email (if you don't have email please put none) *
Best way to contact you? *
What would you like to get out of our online classes? *
Do you accept the following Online Group Rules? *
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Do you agree to our Confidentiality Agreement? *
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Do you Consent For Service? *
If Yes, please sign your name and date below .
If Yes, please sign your name and date below .
Any additional comments?
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