Registration

Reach Registration

Use this one form to register for REACH or for the Teen Life Skills programme, both run by Word and Life Church.

Choose whichever applies below, and the rest of the form will follow.

Which programme are you registering for? *

REACHFor Addiction, Hurts and Hang-ups or Habits.Teen Life SkillsRegistering a young person for the programme.

REACH is a recovery and support programme run by Word and Life Church. You can read more about who we are and how our groups work at reachrecovery.co.za.

Why we ask for this: everything below helps us prepare for your first intake interview. That means matching you with the right group, arranging a social worker assessment if one is needed and, for court, work or school referrals or where chemical addiction is involved, organising weekly testing.

Nothing you submit here is final. A member of our team reviews every registration and will contact you to talk it through before anything is confirmed.

Your privacy: everything you share is confidential and protected under POPIA. Sensitive details are encrypted and only ever reviewed by REACH leadership as part of your intake.

I'm registering as *

AttendeeI want to attend REACH.SupporterI'm supporting someone already at REACH.

Your name *

Email address *

Phone number *

Address *

Birthdate *

Gender

Marital status

Who at REACH are you supporting? *

Their full name, so we can match this up on our side.

Their phone number (if you have it)

Contact by SMS/emailYou may contact me by SMS and email about my programme, such as reminders, attendance and other updates. This is optional and I can withdraw it at any time.

Consent *I consent to REACH Recovery collecting and processing my personal information, including health or addiction related information where relevant, to register and support me in its programmes, and to share it only with service providers who help deliver those services. I may access, correct or withdraw this consent at any time.

Read our privacy notice.

Your signature *

Type your full legal name to confirm the consent above.

You can read more about REACH and how our groups work at reachrecovery.co.za.

Nothing you submit here is final. A member of our team will contact you to talk it through before anything is confirmed.

Your privacy: everything you share is confidential and protected under POPIA. Sensitive details are encrypted and only ever reviewed by REACH leadership as part of intake.

Parent, or guardian, registering *

Add a section per parent or guardian.

Parent / guardian 1

Relationship to the child, or children, belowMarital statusHelps us know whether the child's other parent needs to be informed or asked for consent.

Both parents attending? Add the second parent or guardian here too, rather than leaving them off.

Contact by SMS/emailYou may contact me by SMS and email about my programme, such as reminders, attendance and other updates. This is optional and I can withdraw it at any time.

Consent *I confirm I am the parent or legal guardian of the child(ren) listed and consent, on their behalf, to REACH Recovery collecting and processing their personal information, including health related information where relevant, to register and support them in the Teen Life Skills programme, sharing it only with service providers who help deliver those services. I may access, correct or withdraw this consent at any time.

Read our privacy notice.

Your signature *

Type your full legal name to confirm the consent above, for every child listed.

I understand *The programme costs R550 per family for the full 6 sessions, and R80 per test where testing applies.

I understand *A certificate is only issued once all 6 sessions have been attended.