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FREEDOM SESSION 2018-2019 REGISTRATION
Copy of FREEDOM SESSION FACILITATOR APPLICATION
Relate Kids Leadership Team Application
Relate Kids Volunteer Terms
RKids - Reference Checks
RKids- Applicant Interviews
Incident Report Form
Main Points Form
Worship Team Interest Form
Rental Inquiry Form
Parking Lot Rental Inquiry Form
FREEDOM SESSIONS FACILITATOR APPLICATION
Name
*
First Name
Last Name
Email Address
*
Address
*
Address 1
Address 2
City
State/Province
Zip/Postal Code
Country
Phone
*
(###)
###
####
Age
*
Relational Status
Single
Dating
Common Law
Married
Separated
Divorced
Widowed
If applicable, please give us a little more information about your relationship status, if you're in one or have ended one. (ie length of marriage, how long ago divorced, how many marriages you've been in.)
Gender
*
Male
Female
Have you attended Freedom Session before?
*
Yes
No
If Yes, When?
Did you:
Complete Freedom Session
Graduate
Have you attended other recovery programs?
*
Yes
No
If Yes, when?
If Yes, what program and where?
How did you hear about us?
*
Do you attend Relate Church?
*
Yes
No
Do you attend another church?
*
Yes
No
If yes, which one?
Are you currently under the care of a
*
Counselor
Psychologist
Psychiatrist
N/A
If yes, are they in favour of you participating in this program? Please explain.
Are you currently on medication for
*
Depression
Anxiety
Insomnia
Eating Disorder
Other emotional / mental illness
N/A
If Yes, please expain.
Registration & Consent
*
By writing my name I hereby give consent, to Relate Church, to use the personal information above/below for my pastoral care, participation in church related activities and emergency care. I understand that my personal information may be given to pastoral and/or church staff, program leaders, event coordinators and emergency personnel on a need to know basis. My personal information will be securely stored in an appropriate place, and will not be passed on to any third parties without my/our prior consent. By signing and dating this form I indicate that I have read, understand and approve the above and that this information will be stored for a minimum of one (1) year. I further understand that neither Freedom Session Resources nor Freedom Session International Ministries has any privilege to this information or responsibility for it.
My Journey
*
Your honest answers to the following questions will help us place you in the FS Small Group we feel will be the most helpful to you. Please check all boxes that apply. Note: while we do our best to accommodate all who register, we reserve the right to accept or deny registrations based on space, leadership ratios or suitability (in our opinion) that FS will be helpful for you.
Has anyone suggested you attend FS?
Do you feel like you are different than “normal”?
Have you been told that your expectations are unrealistic?
Do you have a strong need for control in your life?
Do you find yourself believing you are unworthy?
Are you a “people-pleaser”?
Does the fear of failure paralyze you into doing nothing?
Do you lie to cover up for someone else’s mistake or drug/alcohol use?
Do you protect others from the natural consequences of their behaviors and/or actions?
Have you had an abortion?
Have you pressured a partner, family member or friend to have an abortion?
Is there one particular event in your life for which you feel intense guilt/shame that you cannot seem to shake and believe you could never be forgiven for?
Are you afraid to upset other people for fear that they will somehow hurt, reject or maybe leave you?
Do you feel like you are personally responsible for other people’s lives, decisions or drug/alcohol use?
Do you make promises or threats that you don’t carry out? (i.e. “If you ever do that again, I’m leaving.”)
Do you/have you experienced feelings of fear/hatred towards the opposite sex?
Do you have trouble believing/receiving God as a loving Father?
Have you ever been physically abused by a male?
Have you ever been physically abused by a female?
Have you ever been sexually abused by a male?
Have you ever been sexually abused by a female?
Do you have gaps in memories from your childhood?
Do you find yourself avoiding relationships or struggling with intimacy?
Have you been sexually promiscuous before/outside of marriage?
Do you smoke?
Do you drink?
Do you drink more than you think you should?
Have you ever struggled with chemical dependency?
Do you find yourself using drugs (prescription and/or illegal), alcohol, or food in secret?
Have you lied to others or made excuses to yourself about your sexual conduct?
Has anyone ever expressed concern about your sexual behavior?
Do you find yourself regularly watching soap operas and or reading fantasy/romance novels?
Do you regularly purchase or view sexually explicit materials? (e.g. magazines, videos or internet)
Have you made efforts to quit a type of sexual behavior and failed?
Does your weight cause you or others to be concerned about your health?
Do you comfort yourself with food when feeling hurt, angry, depressed or bored?
Are you significantly over or under weight according to others?
Have you ever had thoughts of suicide?
If yes, within the last twelve months?
Do you feel alone in your problem?
Do you find yourself trying to change, regulate and control others instead of yourself?
Do you find it hard to trust, especially those in authority?
Do you avoid physical intimacy?
Do you avoid emotional intimacy?
If married, do you avoid sexual intimacy?
Thank you!