Please fill-out & drop off or mail to: 15061 Springdale Street Suite 109, Huntington Beach, CA 92649
Or email to ~ 714-897-7500 fax 714-897-7580 ~ www.Horizonpc.org
Date: ______
Name: ______Phone # ______
Address: ______City, Zip______
Marital Status: ______Birth Date:______Email: ______
Occupation: ______Previous Occupation: ______
1. Do you consider yourself a Christian? Yes____No____
2. What is a Christian? ______
______
______
3. When did you become a Christian? ______
Please share the circumstances that led you to become a believer ______
______
4. How has your life changed since your personal relationship with Jesus began?
______
______
______
5. Please provide the following information on your local church:
Name: ______
Address: ______
City, ZIP______Pastor’s Name______
Describe positions held/services performed within the church:
______
May we call your pastor for a reference? ______
Please provide the following information about yourself:
6. What is the extent of your formal education?______
______
Areas of concentration:______
Biblical studies or educational experiences:______
______
7. Briefly state why you are interested in volunteering with HPC:______
______
8. How does your spouse/family support your involvement with HPC? ______
______
9. What special gifts, talents or personality traits do you bring to this ministry? ______
______
______
10. Have you ever counseled a woman who was considering an abortion? No ______
Yes ______Please explain______
______
11. Have you ever had any traumatic experiences related to abortion? No_____ Yes_____
Please explain______
______
12. If you personally had an abortion, have you attended a Post Abortion Recovery Bible Study? No_____ Yes_____ If yes, Which Study?______
13. Have you ever known an unwed mother? No_____Yes______
Please explain______
______
13. Under what circumstances, if any, is abortion justifiable in your opinion?
Please explain______
______
Personal Abortion Knowledge:
14. In this section, please make a general evaluation of your knowledge in the following areas:
A. Knowledge of how abortions are performed /methods used to perform abortions:
Excellent _____Good_____Fair_____Poor_____
B. Knowledge of existing laws regulating abortion:
Excellent _____Good_____Fair_____Poor_____
C. Knowledge of what the bible teaches, directly or indirectly about abortion:
Excellent _____Good_____Fair_____Poor_____
15. What questions do you feel you have concerning abortion and the sanctity of life?
______
______
16. When do you feel sexual relations are morally permissible?
______
______
17. Are you currently seeking to adopt a child? Yes ______No______
18. Are you uncomfortable with any aspect of the HPC Statement of Faith? Yes ______
No_____ Explain______
______
19. Please list any books, videos of other materials that you have read or viewed that relate to abortion, pregnancy or alternatives to abortion:
______
______
Please let us know the following volunteer opportunities which interest you. Please feel free to choose as many areas that you wish.
In-House Volunteer Opportunities
_____ Client Advocate
_____ Male Client Advocate
_____ Earn While You Learn Facilitator/Mentor
_____ Mailing Assistant
_____ Baby Store Helper
_____ Cleaning/Housekeeping Volunteer
_____ Grant Writer
_____Fix-It/Construction/Maintenance
_____Prayer Ministry
_____Medical/Ultrasound
Outreach Volunteer Opportunities
_____ Sexual Integrity Speaker
_____ Baby Shower Support Team
_____ Church Liaison
_____ Fundraising Team
_____ Meal Ministry Support Team
_____ Community Awareness
_____ Post Abortion Peer Counselor
** Please refer to “volunteer link” on the HPC website for detailed information on volunteer opportunities: www.horizonpc.org.**
Please find attached our Statement of Faith & Principle. Please return all completed forms to Horizon Pregnancy Clinic.
revised 7/29/2014 DT & MR
Statement of Faith
1. We believe the Bible to be the inspired, the only infallible, authoritative Word of God.
2. We believe that there is one God, eternally existent in three persons. Father, Son and Holy Spirit.
3. We believe in the deity of our Lord Jesus Christ, in His virgin birth, in His sinless life, In His miracles, in His vicarious and atoning death through His shed blood, in His bodily resurrection, in His ascension to the right hand of the Father, and in His personal return in power and glory.
4. We believe that for the salvation of lost and sinful man, regeneration by the Holy Spirit is absolutely essential, and that this salvation is received through faith in Jesus Christ as Savior and Lord and not as a result of good works.
5. We believe in the present ministry of the Holy Spirit by whose indwelling the Christian is enabled to live a godly life and to perform good works.
6. We believe in the bodily resurrection of the saved and lost, the eternal existence of all people either in heaven or hell, in divine judgments, rewards and punishments.
7. We believe in the spiritual unity of believers in our Lord Jesus Christ.
Please sign and date in agreement after reading the Statement of Faith:
______
Print Name
______
Signature Date
Statement of Principle
1. Horizon Pregnancy Clinic (HPC) is a Christian organization, committed to ministering to women with crisis pregnancies both in word and in deed. Commensurate with this purpose, those who labor as HPC board members, directors, staff and volunteers are expected to know Jesus Christ as their personal Savior and Lord.
2. HPC is committed to providing its clients with accurate and complete information about both prenatal development and abortion. We are also committed to unconditional love. We desire to show Christian love and compassion to all clients with whom we come in contact, regardless of the decision they make, their lifestyle choices, and the outcome of their pregnancy.
3. HPC is committed to integrity in dealing with clients – earning their trust, providing accurate information and services. We are committed to sharing the truth regarding pregnancy, abortion and abstinence with confidentiality.
4. HPC is committed to assisting women to carry to term by providing emotional support and practical assistance. Through the provision of God’s people and the community at large, women may face the future with hope and plan constructively for themselves and their babies.
5. HPC is committed to teaching wise life choices in regards to sexuality and relationships, including abstinence until marriage, choosing healthy relationships and making choices that show respect to the opposite sex.
6. HPC does not discriminate in providing services because of race, creed, color, national origin, age or marital status of its clients.
7. HPC does not recommend, provide, or refer for abortion or abortifacients. We are committed, however, to providing confidential post-abortive support.
8. HPC offers assistance free of charge at all times.
9. All information privy to HPC documented in the computer, verbal or written will all be held with confidentiality. All Donor financial giving, addresses and personal information shall remain confidential. All Client information will also be held with confidentiality to including their personal testimonies.
10. HPC is committed to creating awareness within the local community of the needs of pregnant women and of the fact that abortion only compounds human need rather than resolving it.
11. HPC does not recommend, provide, or refer single women for contraceptives.
Statement of Principle, continued page 2
12. HPC recognizes the validity of adoption as one alternative to abortion but is not biased toward adoption compared to other life-saving alternatives. HPC is independent of adoption agencies and relates to them as any other helpful referral source. We do not enter into contractual relationships with them. HPC neither initiate nor facilitate independent adoptions in states where it is legal.
13. While we recognize the need for people to be involved in various activist organizations, Horizon Pregnancy Clinic does not associate with any organization or event that that uses inflammatory practices including but not limited to pictures of aborted fetuses and signs with statements making accusations of murder. We recognize that our presence at these events can easily be associated with Horizon Pregnancy Clinic. Therefore we ask that each volunteer, staff and board member initial the following statement.
As a board member, staff or volunteer I will not attend any event that utilizes these tactics. ______ (initial)
Please sign and date in agreement after reading the Statement of Principle:
______
Print Name
______
Signature Date
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