CIC Form

Covenant Evangelical Free Church

:

Care-in-Covenant Request Form

  = Required Information

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 cic@cefc.org.sg if you have any query."
http://www.cefc.org.sg/images/media/pdf/indemnity_consent_form.pdf
  
 
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