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Christ City of Refuge Admission Inquiry
We are currently at capacity with a waiting list. If you would like to be added to the list and/or would like a callback, please fill out this intake form and someone from our team will contact you as soon as possible. We are experiencing a high volume of requests and want to help as many people as possible, so please be patient with us.

If you need immediate shelter assistance, here are some options for the Florence, SC area:
Salvation Army-Florence (843-662-4461)
House of Hope Community Shelter (843-731-9315)
Resurrection Restoration Center for the Homeless (843-601-7935)

**Please answer identification questions as it matches your state identification.**
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First Name *
Last Name *
DOB
MM
/
DD
/
YYYY
Telephone Number *
Gender *
Race *
Marital Status
Last Address Resided *
Other Counties in SC Resided
Other States Resided
Spouse Name and Address (if applicable)
Do you have transportation?
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Do you have a valid driver's license? *
Do you currently have a job? *
If yes, where do you work?
Do you have an alcohol or drug reliance? *
If yes to above question, please explain further.
Have you ever been arrested? *
If yes, what was the charge(s)?
Have you ever been convicted of a felony? *
If yes, when?
Are you, or have you ever been required to register as a sex offender? *
If yes to above question, what were the charges and state of charges?
Tell us a little about your story, what is something you would like for us to know...
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