Godfrey Ministries: Warrior Young Adults

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Participant Name* This field is required.
First Name
Last Name
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Cell Phone Number* This field is required.
Area Code
Phone Number
3
Email* This field is required.
example@example.com
4
Age* This field is required.
5
Where do you attend church?* This field is required.
6
Please describe the problem, including how long the problem has been going on* This field is required.
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Ok
7
Do you have a counselor or therapist?* This field is required.
YESNO
8
Have you discussed the problem with anyone?* This field is required.e.g. Pastor, Family, Roommates etc.
YESNO
9
Please explain any support you have received from anyone you have discussed this with* This field is required.If this is not applicable them please type "not applicable"
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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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