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Living Five17 Reconciliation Ministry
Starts Wednesday Feb. 23, 2022 @ 6:30 PM in Albemarle, NC ( Please Fill out Required Fields)
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First and Last Name
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Your answer
Phone Number (Ex: 999-999-999)
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Your answer
Emergency Contact (Name)
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Your answer
Emergency Contact ( Phone # ex: 999-999-999)
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Your answer
Are you currently using any substances?
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Yes
No
What are the current issues you are struggling with?
Your answer
What brought you to Living Five17?
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Struggling with Addiction or other life controlling issues
Need Support Group
To learn more about "Knowing Jesus and Living New."
Other:
Do you understand that this program is a "Christ-Centered" Program?
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Yes
No
Have you attended AA, NA, Celebrate Recovery, or any other support Group?
Yes
No
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Do you live in Stanly County?
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Yes
No
Do you have transportation?
Yes
No
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