CHURCH ASSISTANCE & RECOVERY EDUCATION
PROGRAMS
INTEREST SURVEY
C.A.R.E. Programs are designed to help meet the needs of members in our community. Please review this survey and let us know which programs you have interest in.
.....................................................I Would.........I May Be.............I Have............I Have
..................................................Like More......Interested........Experience.........Good
.................................................Information....In Helping..........Helping.........Information
.................Programs................. .On This........With This..........With This.......About This
Alcohol Addiction..................._______........_______........._______......._______
Drug Addiction........................_______........_______........._______......._______
Tobacco Addiction.................._______........_______........._______......._______
Anger Management................_______........_______........._______......._______
Grief Counseling....................._______........_______........._______......._______
Clothing Closet........................_______........_______........._______......._______
Food Pantry............................._______........_______........._______......._______
Shelter Assistance..................._______........_______........_______......._______
Financial Assistance..............._______........_______........_______......._______
Weight Loss ............................_______........_______........_______......._______
Marriage Counseling.............._______........_______........_______......._______
Parenting Counseling............._______........_______........_______......._______
Divorce Support Group.........._______........_______........_______......._______
Care-Taker Support Group...._______........_______........_______......._______
Alzheimer’s Support Group..._______........_______........_______......._______
Cancer Support Group............_______........_______........_______......._______
Diabetic Support Group.........._______........_______........_______......._______
Senior Citizen Activities.........._______........_______........_______......._______
Teen / Youth Activities..........._______........_______........._______......._______
* Please list on the back of this page any other programs you would like to see offered.
Name ________________________________ Phone # __________________
Address_______________________________ Cell # ____________________
_____________________________________ FAX # ___________________
E-Mail ______________________________________________
How would you like to be contacted? ___ Phone, ___ Cell, ___ FAX, ___ Mail, ___ E-Mail
..................................................Like More......Interested........Experience.........Good
.................................................Information....In Helping..........Helping.........Information
.................Programs................. .On This........With This..........With This.......About This
Alcohol Addiction..................._______........_______........._______......._______
Drug Addiction........................_______........_______........._______......._______
Tobacco Addiction.................._______........_______........._______......._______
Anger Management................_______........_______........._______......._______
Grief Counseling....................._______........_______........._______......._______
Clothing Closet........................_______........_______........._______......._______
Food Pantry............................._______........_______........._______......._______
Shelter Assistance..................._______........_______........_______......._______
Financial Assistance..............._______........_______........_______......._______
Weight Loss ............................_______........_______........_______......._______
Marriage Counseling.............._______........_______........_______......._______
Parenting Counseling............._______........_______........_______......._______
Divorce Support Group.........._______........_______........_______......._______
Care-Taker Support Group...._______........_______........_______......._______
Alzheimer’s Support Group..._______........_______........_______......._______
Cancer Support Group............_______........_______........_______......._______
Diabetic Support Group.........._______........_______........_______......._______
Senior Citizen Activities.........._______........_______........_______......._______
Teen / Youth Activities..........._______........_______........._______......._______
* Please list on the back of this page any other programs you would like to see offered.
Name ________________________________ Phone # __________________
Address_______________________________ Cell # ____________________
_____________________________________ FAX # ___________________
E-Mail ______________________________________________
How would you like to be contacted? ___ Phone, ___ Cell, ___ FAX, ___ Mail, ___ E-Mail
