JAC-Jewish Addiction Circle This form is 100% confidential and the only person who will see it is Rabbi Corber at JACS Vancouver.Please complete the following questionnaire. Question Title * 1. First Name Question Title * 2. Last Name Question Title * 3. Address Address City Province Postal Code Question Title * 4. Email Question Title * 5. Phone Number Question Title * 6. Are you in recovery or struggling with substance Yes No Question Title * 7. What's going on? ((Anything you share will remain confidential)) Question Title * 8. Are you Jewish? Yes No Question Title * 9. If you selected "No", please share briefly why you are interested in attending. Community Agreement By joining the Jewish Addiction 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. Question Title * 10. I agree to the above statements and understand that violating these terms may result in removal from the group. Yes Done
