CIC Form

Covenant Evangelical Free Church


Care-in-Covenant Request Form

  = Required Information


CGL Lookup (New Window)

Counselling & Medical History


Applicant's Particulars (ALL fields in this section are mandatory)


Spouse's Particulars (For Family Counselling, ALL fields in this section are mandatory)


Particulars of Children


Emergency Contact


Indemnity, Confidentiality & Consent

"Please read the indemnity, confidentiality and consent document. By clicking “I agree” below, you and all other counselees in this form (including any minor), are agreeing to all the clauses stated. If you disagree, we will not proceed with the counselling services. You may write to if you have any query."
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