Personal Restoration — YWAM Châtel

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- FCM (IBC)
- ATCM (MMBC)
- ABC
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Street Address

City, State, Zip

Phone Number

a place for healing and restoration

Your Custom Text Here

Home
About
Accueil
Training
Seminars
Personal Restoration
Apply
Contact
Présentation
Formation
- FCM (IBC)
- ATCM (MMBC)
- ABC
- CFC
- séminaires
Inscription
Contact

Application Form - please answer all questions

Name *

First Name

Last Name

Gender *

Male

Female

Home Address - include street address plus city/town *

Email *

Phone

Nationality *

Age *

Civil Status *

Occupation *

Name / Sex / Birth Dates of children

How did you hear about our centre? *

Do you speak English? *

Fluently

Conversationally

Rudimentary

Not at all

Do you speak French? *

Fluently

Conversationally

Rudimentary

Not at all

Do you speak German?

Fluently

Conversationally

Rudimentary

Not at all

Please answer the following questions:

I request *

debriefing*

one or more periodical counseling sessions

a time of rest

a process of inner healing duration to be worked out

I have recently left a cult and would like help to recover my life and my identity

other (please explain)

If requesting for debriefing, for: *

transition

particular stress

crisis or trauma

In which country have you been operating? *

In which setting? *

Who would cover costs? *

The above

Myself

Other

If yourself, are you: *

Salaried

Living by faith

In your opinion, what is the main reason for your looking for help at this time? *

Have you already sought help for this problem? If yes, when and with whom? *

Important: What are your expectations with this request? *

(possibilité d’écrire sur une feuille séparée)

Are you being or have you ever been accompanied by a *

If so, when and with what frequency? And for what reason?

Are you currently taking prescription medication? *

Yes

If yes, for what condition?

Are you currently active in a church? *

Yes

If yes, which and where?

Is there anything else we should know about? e.g.: health problems, allergies, food intolerances, addiction, recent death in the family, separation or divorce…? *

Would you need a visa for Switzerland? If so, do you know long it would take to obtain? *

Please indicate when you would prefer to come to Châtel *

Contact person in case of emergency during your stay at Châtel

Name *

First Name

Last Name

Relationship *

Email *

Telephone *

If you have any questions before completing this form we shall be happy to reply by email or telephone.

Unless you indicate to the contrary, this form will be retained - confidentially, on our files.

I would prefer not:

Typing your name here will be considered a signature *

First Name

Last Name

Thank you! We will be in touch with you soon.

Please do check your spam folder if you don’t hear from us in couple days, we have noticed sometimes our emails get thrown there unfortunately.

YWAM Chatel

YWAM / JEM Châtel is a ministry of Youth With a Mission (YWAM) International and University of the Nations (UofN)
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