A Jewish-Informed Support Group for Loved Ones of Those Struggling with Addiction.

This form is 100% confidential and the only person who will see it is Rabbi Corber at JACS Vancouver.

Please complete the following questionnaire.

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* 1. First Name

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* 2. Last Name

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* 3. Address

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* 4. Email

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* 5. Phone Number

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* 6. Is someone you love in recovery, or still struggling with addiction to:

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* 7. Are you Jewish?

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* 8. If you selected "No", please share briefly why you are interested in attending JACS Family Circle meetings.

Community Agreement
By joining the JACS Family Circle, I acknowledge that I am entering a recovery space created for the spiritual and physical safety of Jewish people, their families, and their allies.
I agree to uphold the following principles:
I will treat all participants with respect and care.
I will not bring any political agenda into this space.
I will not share meeting times or locations with anyone outside the group.

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* 9. I agree to the above statements and understand that violating these terms may result in removal from the group.

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