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Prospective Resident Information
Please fill out the following form in order for us to know more about you.
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Name
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Email
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Phone Number
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What date are you requesting entry into the program?
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Tell us why you would like to enter Wilderness Refuge Recovery Ministries?
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Please list any medications that you are currently taking.
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Are you on probation? If so, please list your conditions of parole and the name and phone number of your parole officer.
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Tell us why you believe you would be an asset to our ministry.
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