Godfrey Ministries: Warrior Teens

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Participant Name* This field is required.
First Name
Last Name
2
Participant Cell Phone Number* This field is required.
Area Code
Phone Number
3
Participant Age* This field is required.
4
Participant's School* This field is required.
5
Name of Parent or Guardian* This field is required.
First Name
Last Name
6
Parent Cell Phone Number* This field is required.
Area Code
Phone Number
7
Parent Email* This field is required.
example@example.com
8
Where do you attend church?* This field is required.
9
Please describe the problem, including how long the problem has been going on* This field is required.
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Ok
Ok
10
Does the participant have a counselor or therapist? * This field is required.
YESNO
11
Have you discussed the problem with any church leaders or pastors?* This field is required.
YESNO
12
Please explain any support you have received from your church* This field is required.If this is not applicable them please type "not applicable"
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Ok
Ok
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Upon submitting you will be redirected to a REQUIRED consent form. This form must be completed for your registration to be complete.* This field is required.Please ensure that your POP-UP BLOCKER is not enabled
I understand that I must fill out the consent form that I will be redirected to after clicking submit.
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