G5 Forms
Complete this form to participate in the Called to Peace Ministries G5 Men's Intervention Group
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Correo electrónico *
DEMOGRAPHIC INFORMATION
First Name *
Last Name *
Date of Birth *
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Cell Phone *
Email *
Address *
City *
State *
Zip code *
Ethnicity/Race *
Where do you worship?    (list name and location...) *
Select the ways you worship and serve in church:  *
Obligatoria
How often are you participating in worship? *
Are you a US military Veteran? *
Employed? *
Employer *
Employer Phone number *
Have you attended a G5 group in the past? *
How did you find out about the G5 group? *
Spouse/Partner Name (or former spouse/partner/person with whom your were violent) *
If victim is other than spouse/partner, what relationship to you? *
Spouse/Partner Address *
Spouse/Partner City *
Spouse/Partner State *
Spouse/Partner Zip Code *
Spouse/Partner Cell Phone *
Spouse/Partner Email *
Spouse/Partner Ethnicity/Race *
How many children do you have? *
Ages of your children *
How many children does your partner have? *
How many children do you have together? *
How long have you been in a relationship  with the person named above? *
LAW ENFORCEMENT/COURT INVOLVEMENT
Have the police been called to your home because of a violent incident with the above-named victim? *
How many times have the police been called? *
Were you arrested for the most recent incident? *
Were you given a ticket? *
Have you been arrested in the past for a violent crime? *
Are you on probation? *
How long is your probation? (in Months) (type NA if this does not apply) *
Who is your probation officer? (type NA if this does not apply) *
What are your probation conditions? *
Obligatoria
Any other conditions of probation? *
Is there an Order for Protection (OFP) against you? *
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