JOURNEY DISCIPLESHIP COURSE - Riverside Community Church, JHB 2021

Riverside Community Church, Johannesburg

25 February 2021 to 12 August 2021
Registration Information

Please note that you will receive an automated email with a document containing all the following information upon submission of your application form, for your convenience.

The meetings will run from 19:00 to 21:30.

It is essential that you are available to attend all of the group meetings, actively participate in the weekly groups, read the required course material and answer the prepared questions in a diligent manner. You may not miss more than two sessions in total. If you are aware that you will miss more than two sessions ahead of time, you will not be considered for participation in this JDC, but recommended for one at a later date. The JDC will break over Easter and the June school holidays.

The JDC is run as a closed group. Thus, candidates apply before the group starts and once the group commences we do not allow any further applications. Please note: Application to these groups is on a first-come-first-serve basis. We have a limited number of places available in each group. As a result, should your application be received after all spaces have been filled, we will have to suggest entry to another JDC at a later time when there is space available. Parents are not permitted to bring children or infants to any of the sessions.
VENUE

PLEASE NOTE: Due to COVID restrictions, THE JDC WILL TAKE PLACE ONLINE VIA ZOOM.

A decision will be made later in the year whether or not to move from online to in-person meetings. It is thus important that applicants live within local area of the JDC.

St.Declan's School for Boys,

Rietvlei Zoo Farm,

101 Swartkoppies Road,

Brackenhurst.

1448
INTERVIEW

You may be required to undergo a telephonic interview once your completed application form has been received. You will be contacted to schedule a convenient time for the interview.
COST

The cost for the JDC is R1650.00, which includes the course manual. Of this, a deposit of R750.00 is required with the completed application form by Monday 25 January 2021.

PLEASE NOTE: APPLICATIONS WILL NOT BE PROCESSED WITHOUT PROOF OF PAYMENT OF THE DEPOSIT.

Upon acceptance to the JDC, the remaining R900.00 must be paid in full by 30 June 2021.

Please note: If you require further information or assistance regarding any of the above contact Jackie Rudd on jackie@edisonlebone.co.za or Anton van Dam on antonvandam00@gmail.com
RIVERSIDE COMMUNITY CHURCH BANK DETAILS

Bank: Standard Bank
Account name: Riverside Community Church
Branch code: 012342
Branch: Alberton
Account number: 081588925

Reference: JDC + Initial + Surname
Personal Information
Full Name *

First Name Surname
Preferred name *
Date of birth *

Month Day Year
Gender *

Female Male
Physical address *

Street Address

Street Address Line 2

City Province

Postal code Country
Home phone number

Area Code Phone Number
Work phone number

Area Code Phone Number
Cell phone number *
E-mail address *
Current marital status *

Single Engaged Widowed Married Divorced Separated
Please indicate for how long:
Number of children: *
Your children's respective ages (e.g. 5, 13, 19...):
Emergency Contact Information

In case of emergency, please contact:
Full name *

First Name(s) Last Name
Physical address *

Street Address

Street Address Line 2

City Province

Postal code Country
Home phone number *

Area Code Phone Number
Work phone number *

Area Code Phone Number
Cell phone number *
E-mail address *
Relationship (e.g. Parent, sibling, friend,etc.) *
Personal History
The following questions help us to assess the level of need that you have, the nature of the problems that you face, and to place you in a suitable small group. Please fill this out with as much detail and as honestly as possible. Your responses will be kept strictly confidential.

The JDC is approximately 20 weeks long and requires a deep level of commitment.
How did you get to hear about JDC? *
What do you hope to get out of this JDC? *
JDC runs for approximately 5 months. We expect participants to attend every group session. If you miss more than 2 sessions you will need to consider attending the next JDC instead. Your commitment will involve working through the course material on your own, sharing within the group and being accountable to a small group leader. Are you willing to commit to attending each JDC support group and all that this commitment involves? *

Yes, I am willing to commit to this No, I am not willing to commit to this
Do you feel strong enough to face the pain that may arise during this support group from exposing current and past shame and hurt in your life? *

Yes No
Participation in JDC requires self-disclosure and confession of sin and brokenness within the context of a small group. Although the leaders give room for participants to grow in trust of the group there is an explicit expectation that you will share your shame, sin and pain with the group. This is part of the group process and an integral part of the model of healing and accountability presented. If you are not willing to share with others this will disqualify you from the group. To what degree are you prepared to be vulnerable and transparent with others in a support group? *
Are you currently being counselled by someone? *

Yes No
Is your counsellor/pastor/church leader aware of your struggle? *

Yes No
Please briefly explain why not, in the space provided.
If you are married, is your spouse aware of your reason for attending? *

Yes No
Please briefly explain why not, in the space provided.
Is this the first JDC you are attending? *

Yes No
Please provide the details of the previous JDC's you have participated in.
Have you ever been in treatment for depression, anxiety or any other psychological disorder? *

Yes No
Please provide the diagnosis thereof (e.g. ADHD/ADD, bipolar, OCD...).
Are you currently on any medication for depression, anxiety or any other psychological disorder? *

Yes No
Please detail what diagnosis the medication seeks to treat (e.g. ADHD/ADD, bipolar, OCD...).
Have you ever been hospitalized for depression, anxiety or any other psychological disorder? *

Yes No
Please provide the details thereof.
Have you ever attempted suicide or been suicidal? *

Yes No
Please provide the details thereof, including when you were last attempted suicide or had suicidal thoughts.
Have you ever struggled with any eating disorders or used food as a source of comfort? *

Yes No
Please provide the details thereof.
Are or were you, or either of your parents, dependent on alcohol and/or substances? *

Yes No
Please provide the details thereof.
Please describe your relationship with your parents (in childhood and adulthood). It is important that you spend time answering this question. You need to describe these relationships over a minimum of 500 words for each parent.
Include at least 500 words about your relationship with your father *

0/800
Include at least 500 words about your relationship with your mother *

0/800
Do you recall any significant traumatic or abusive incidents in your life (i.e. verbal, physical, sexual, emotional, incest)? *

Yes No
Please provide the details thereof.
Have you ever or do you struggle with any same-sex fantasies or feelings? *

Yes No
At what age did you realise that you were attracted to the same sex?
Have you ever experienced a homosexual sexual encounter? *

Yes No
At what age did you have your first homosexual encounter?
Have you ever been involved in a homosexual sexual relationship? *

Yes No
Are you currently involved in a homosexual sexual relationship? *

Yes No
Have you ever had a heterosexual sexual encounter? *

Yes No
At what age did you have your first heterosexual encounter?
Have you ever been involved in a heterosexual sexual relationship? *

Yes No
Are you currently involved in a heterosexual sexual relationship outside of marriage? *

Yes No
Do you feel comfortable talking about your sexual issues in a group with people who struggle with homosexual/heterosexual addictions? *

Yes No
Please elaborate in the space provided.
If the reason for attending JDC is sexual brokenness, please indicate who the sexually broken person is. If you select 'Other', please indicate who in the space provided.

Myself Partner/Spouse
In relation to the question above what are or have been the major areas of sexual struggle?

Obsessive / lustful sexual thought / chronic fantasies Same-sex attraction Pornography, including reading sexual material / softcore media Homosexual / heterosexual sex outside of / before marriage Adultery / affairs Anonymous sexual encounters Phone sex / cyber sex / sexting Paedophilia Beastiality Polyamory / swinging / polygamy Compulsive masturbation Prostitution Sadomasochism Obsession with having sex Fetishism Paraphilia
Have you ever been examined for sexually transmitted diseases/infections (STDs/STIs)? *

Yes No
Have you ever been tested for HIV/AIDS or the HIV/AIDS antibodies? *

Yes No
If your struggle is relational, please describe the nature of the relational issue(s) in the space provided.
What impact has your relationship with Christ had upon your areas of brokenness? *
At what point in your life did you consider yourself a Christian? *
Please describe your conversion experience in the space provided. *
Do you consider your church to be charismatic? *

Yes No
What is your current church affiliation? *
How long have you been attending at your current church? *
Do you attend regularly? *

Yes No
Are you currently participating in ongoing fellowship within your church, besides a regular weekly service? *

Yes No
Please provide the details thereof.
Please list your past church affiliation(s) or religious instruction beginning in childhood. *
Have you ever been involved in any non-Christian spiritual or religious experiences/ ceremonies/ events/ indoctrination/ training/ abuse? *

Yes No
If your answer to the above question is 'Ýes', please indicate in the list below which are applicable or provide the details thereof in the available space.

Abortion Mediums Abuse (Emotional, physical, sexual, spiritual) Metaphysical healing Alcoholism Mind reading Ancestral worship Molestation Animism Mormonism Astral projection New Age movement Astrology New/Old Apostolic movement Automatic writing Numerology Beastiality Occulting gaming and roleplay (e.g. dungeons and dragons) Black magic Occultic literature Blood covenant Ouija board Buddhism Palm reading Card laying Parapsychology Channelling Paedophilia Children of God movement Promiscuity Christian Science movement Psychic phenomena Clairvoyance Rape Crystal ball Reincarnation Curses Rosicrucian movement Divination Sadomasochism Divining Satanism Eastern religions Scientology Extrasensory perception Seances EST (The Forum, Lifespring) Second sight Fortune telling Shriners movement Freemasons Silva mind control Goddess worship Spiritism Hare Krishna Tarot cards Hinduism Tea leaf reading Horoscopes The Way International movement Hypnosis Transcendental meditation Islam Unification Church Jean Dixon movement Water witching Jehova's Witness movement White magic Kabbalah Witchcraft Levitation Witchdoctors Masons Yoga
Has anyone in your family ever been involved in any non-Christian spiritual or religious experiences/ ceremonies/ events/ indoctrination/ training/ abuse? *

Yes No
If your answer to the above question is 'Ýes', please indicate in the list below which are applicable or provide the details thereof in the available space.

Abortion Mediums Abuse (Emotional, physical, sexual, spiritual) Metaphysical healing Alcoholism Mind reading Ancestral worship Molestation Animism Mormonism Astral projection New Age movement Astrology New/Old Apostolic movement Automatic writing Numerology Beastiality Occulting gaming and roleplay (e.g. dungeons and dragons) Black magic Occultic literature Blood covenant Ouija board Buddhism Palm reading Card laying Parapsychology Channelling Paedophilia Children of God movement Promiscuity Christian Science movement Psychic phenomena Clairvoyance Rape Crystal ball Reincarnation Curses Rosicrucian movement Divination Sadomasochism Divining Satanism Eastern religions Scientology Extrasensory perception Seances EST (The Forum, Lifespring) Second sight Fortune telling Shriners movement Freemasons Silva mind control Goddess worship Spiritism Hare Krishna Tarot cards Hinduism Tea leaf reading Horoscopes The Way International movement Hypnosis Transcendental meditation Islam Unification Church Jean Dixon movement Water witching Jehova's Witness movement White magic Kabbalah Witchcraft Levitation Witchdoctors Masons Yoga
Privacy Policy and Consent

Journey South Africa respects your privacy. We protect your personal information (name, address, phone number and email address) and adhere to all required legislative requirements with respect to protecting your privacy. We do not rent, sell, trade or distribute our mailing list to anyone.

The information you provide in applying for this course is kept strictly confidential, and all such documents are securely stored. Only the program coordinator and your small group leaders will read your application.

We want to stay in touch with you. Please indicate your consent to receive emails from us about programs, events and stories of hope. You can unsubscribe from our mailing list by clicking the link at the bottom of the emails sent by Journey South Africa.
*

Yes, please add me to the Journey South Africa e-newsletter list. No, please don't add me to the Journey South Africa e-newsletter list.
Signature *
Confidentiality Agreement
Please tick to indicate your agreement *
To provide a safe environment, JSA ministry team members will keep all disclosures confidential, with these four exceptions:
1. Ministry team members may discuss matters disclosed by participants to receive supervision and oversight from the ministry team. Any disclosures made will not include the name or identifying details of any participant.
2. Any Journey group member who discloses that they are currently or have engaged in sexual activity outside of their marriage will be expected to process the need to disclose to their partner/spouse with the help of the support group leader. If they choose not to and their behaviour is putting the health of their partner/spouse at risk, we will be obliged to disclose this information to their partner/spouse.
3. Any JDC participant who discloses intentions to take harmful, dangerous or criminal action against another person or against themselves will require JSA to warn appropriate individuals of such intentions. JSA is required, by law, to report any suspected acts of child abuse or neglect. Those warned about a participant’s harmful actions may include:
  1. the person or family of the person who is likely to suffer the results of harmful behaviour;
  2. the family of the participant who intends to harm himself or herself or someone else;
  3. associates or friends of those threatened or making threats, and,
  4. law enforcement officials or child protection services.
The JDC coordinator or group leader will inform the participant beforehand of his or her intention to report such information to any of the above mentioned people.

4.JSA operates under the blessing and support of the local church. JSA reserves the right to disclose confidential information to the pastor of a participant’s church for the purpose of pastoral responsibility and care (e.g. if a participant is in a position of responsibility in their church community and is involved in illicit activity with other members of the congregation). A participant will be encouraged and supported to disclose this information themselves, and a JSA small group leader/coordinator may attend as a support person for the purpose of disclosure. Failing this, JSA will take steps necessary to disclose the needed information, and participants will be informed beforehand of any such intention.
I understand and will abide by this Confidentiality Policy. *
Policy for Interaction with Other Participants
Over the course of our experience, we have found that certain things enhance healthy group dynamics and certain activities detract from the Journey Discipleship Course (hereafter “JDC”) being a healthy, healing experience. One of the important goals of JDC is to create a holy, safe and intimate context where the deep wounds of each group member’s heart can rise to the surface and begin to be healed through the care and prayer within the group.

Because many JDC participants suffer from emotional and/or sexual addictions, we have learned that certain boundaries must be erected to safeguard the intimacy and sanctity of the group. We have seen the effectiveness of JDC be greatly undermined when people intertwine the unique intimacy forged in JDC with socializing outside of the group.

In order to maintain our goals of providing intimacy and safety within the group, we ask that you refrain from social contact outside of the parameters of JDC with other group members for the course of the JDC.

An exception would be if a small group wishes to do an activity together outside of normal JDC activities. We ask that the small group leader be made aware and that the entire small group be invited.

Over the course of JDC, the coordinator or small group leader may make exceptions to this policy or modify aspects of this policy as seems appropriate to individual or small group situations.

Journey South Africa does value the importance of healthy friendships. We believe that the primary place for those heart investments to be made is in the context of one’s local church. We believe that it is important to develop relationships with people who do not share our same sexual vulnerability in the context of the church.

JDC is a unique context where we can discuss and receive healing from the fears which inhibit our greater integration into the Church and into healthy friendships.
Please tick to indicate your agreement *
Signature *
Agreement and Release from Liability
Please tick to indicate your agreement *
Signature *
Statement of Faith and Beliefs
Statement of Faith
- We believe the Old and New Testaments are the inspired Word of God, the final authority of doctrine and instruction in living.
- We believe in one God, existing eternally in three persons: Father, Son and Holy Spirit.
- We believe in the deity of our Lord Jesus Christ, fully man and fully God, only Son of the Father. He was conceived by the Holy Spirit, born of the Virgin Mary, and lived a sinless life. He suffered under Pontius Pilate, was crucified, buried and rose physically from the dead. He ascended to the right hand of the Father and will come again in power and glory.
- We believe that faith alone in Jesus Christ as Saviour and Lord frees us from the mastery of sin, and its consequences of death and eternal damnation. He assumed the penalty of death Himself, and enables us to live out of His resurrected life unto eternity.
- We believe the Holy Spirit carries out this work of renewal in our lives, empowering us to grow in loving union with our Heavenly Father and to walk in obedience to His will.
- We believe that the church of Jesus Christ is formed of all those who know Him as their Saviour and Lord, regardless of denominational beliefs.
- We believe God created man and woman in His image, and as such, each person has worth and value because his or her identity is rooted in God.
I understand this statement of faith of JSA. I agree to enter the JDC knowing that the teaching and ministry I receive is based on this statement of faith. If I disagree with any of this, I agree to make my opinion known to the program coordinator prior to the start of the JDC, and I agree to not contentiously debate these beliefs with other participants during the course of the JDC. *
Statement of Beliefs on Human Sexuality

In His generosity and love, God has poured out good gifts on all people. The most important of these is our capacity for relationship and the ability to reach out to God in love, and to know the delight that He takes in us. People are also created to be part of intimate, loving, human relationships marked by mutual care and joyful service within the bonds of friendship, family, community and marriage.
- Sexuality (and genital sex in particular) is among these gifts and is inherently good.
- To receive the gift of sex in a way that is most life-giving and joyful, it is reserved for marriage, which is undertaken by one man and one woman together as a life-long journey toward greater intimacy, mutual spiritual maturity, and self-giving love.
- God's gifts to us can be misused through sexual acts outside of marriage (such as oral sex or mutual masturbation, pornography use, or compulsive masturbation).
- God calls all people to explore their identity as His beloved children, not only followers but brothers and sisters of Jesus, and members of the family of God. Each of us is loved by God unconditionally, regardless of sexual orientation or behaviour.*
* Journey South Africa (hereafter” JSA”) is a discipleship ministry and therefore does not seek to change same-sex orientation/attraction.
I understand this statement of faith and beliefs of JSA. I agree to enter the JDC knowing that the teaching and ministry I receive is based on this statement of beliefs. If I disagree with any of this, I agree to make my opinion known to the program coordinator prior to the start of the JDC, and I agree to not contentiously debate these beliefs with other participants during the course of the JDC. *
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Personal Information

Emergency Contact Information

Personal History

Confidentiality Agreement

Policy for Interaction with Other Participants

Agreement and Release from Liability

Statement of Faith and Beliefs