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Please tell us more about yourself and the care you are seeking.
Email address *
Full Name *
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Names of any additional people seeking care (if applicable)
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Phone Number *
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What is your host country? *
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What is your role/job description? *
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Organization/Business/Ministry you are serving with *
Your answer
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: https://safeplaceministry.org/member-care-consent-form/ *
I want to inquire about: *
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General Reason for Inquiry *
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