Overcomers Application

Today's Date
MM slash DD slash YYYY
Your Birthdate
MM slash DD slash YYYY
The following information is considered confidential and will be dealt with as such. Your complete and honest answers will assist us in determining your eligibility and prevent delays in entering the program. Intentionally falsifying any answers could result in being disqualified from the Overcomers Program.
Name*
First Last
Address*
Street Address City State ZIP Code
Phone*
Email
Why should you be selected for the Overcomer's Program?

Spiritual Assesment
Have you been, or are you now affiliated with any organized religion?
- Yes
- No
If yes, what is the name & type
Do you currently attend services?
- Yes
- No
If yes, where?
Leader's Name
First Last
Are you satisfied with your spiritual health?
- Yes
- No
Is spiritual growth important to you?
- Yes
- No
State in your own words why you need to join Overcomers and describe your commitment to changing your life.

Waivers
Check each of the following
I understand that the Overcomers program is not a detoxification facility.*
- I agree
I understand that the Overcomers program is not a medical program.*
- I agree
I understand that the Overcomers program does not pay for any medications.*
- I agree
I understand that as part of the Overcomers program I will be assigned a task assignment and I waive my right to legal action against Miracle Hill Ministries and its representatives if I am hurt during that task.*
- I agree
I understand that Miracle Hill provides limited transportation to me while participating in the Overcomers program and I waive my right to legal action against Miracle Hill and its representatives if injured while being transported by any of the ministries vehicles.*
- I agree
I understand that the Overcomers staff may direct me to transitional housing for a period of time between 6 and 12 months. I also understand that refusal to accept that recommendation may be grounds for separation from the Overcomers program.*
- I agree
I understand that the Overcomers program is not a licensed treatment center and I waive my right to legal action against Miracle Hill, its staff or volunteers based on any counsel I receive.*
- I agree

Problem Areas