Women wishing to enter the residential treatment program may now apply by downloading the application form        or completing the online application form below.


Please submit downloaded application forms to:

E: office@chooselifeministry.ca

F: 306.925.4808

M: P.O. Box 426 Carnduff, SK  S0C 0S0

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How did you hear about us?
Does your spouse/family support your decision to go to Choose Life?
Do you have Children?
Are you pregnant?
Has a doctor confirmed your pregnancy?
Which are you considering?
Is the birth father aware of your pregnancy?
Did you graduate high school?
Did you attend any modified classes?
Do you have any allergies? If yes, please list.
Are you on any mediations?
Have you ever been arrested?
Do you have any court cases pending?
Are you currently incarcerated?
Do you have a history of violence?
Please Select all the Substances You Have Experimented With:
Select all that you have received as an official diagnosis:
Have you ever recieved counseling?
Select all that you have experienced:
Have you ever been involved in prostitution?
Have you ever experienced confusion about your sexuality?
Have you ever attempted to commit suicide?
Have you ever attempted harmed yourself?
Have you ever witnessed or been involved in occult activities?
Have you ever been abused in any of these activities?
Did you grow up in a Christian faith group?
What is your present relationship with Jesus Christ? Your admission into our program is not dependant on this answer, please feel free to answer honestly.

Thank you! We’ll be in touch.