Please tell us more about yourself and the care you are seeking.
Names of any additional people seeking care (if applicable)
What is your host country?
What is your role/job title
organization/business/ministry you are serving with
Does your organization/ministry/business need a report of your care? If so, we will email you a release of information form.
To receive member care with Safe Place Ministry, please read and review our Member Care Consent Form here:
I have read and agree to the terms and services listed in Safe Place Ministry's Member Care Consent Form.
I am not comfortable signing the Member Care Consent form at this time but would like to speak with a SPM staff member before signing.
General reason for inquiry (choose one):
Individual Member Care
Exit Strategy Planning
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