As a reminder, we will send this form once a year when your membership renewal date approaches.
Business Phone and Address
Do you have any current complaints, charges or investigations pending against you, or have you ever been issued probation or other compliance orders as a result of a complaint or investigation?
Have you ever engaged in any sexual misconduct ("sexual misconduct" is defined as: any actual or alleged erotic physical contact or attempt, threat or proposal thereof) with any of your former or current clients, or any current or former clients' spouse, or any person with direct relationship to the current or former client (for example: guardian, blood relative to the patient or any person sharing the client's domicile)?
Please mark your response below each description
The Preeminence of EvangelismWe believe that the ultimate purpose of life is to know and glorify God and to attain eternal life through Jesus Christ our Lord, beginning within our own families and then reaching out to a suffering humanity that needs to embrace His love and sacrifice.
The Permanence of MarriageWe believe that the institution of marriage is a sacred covenant designed by God to model the love of Christ for His people and to serve both the public and private good as the basic building block of human civilization. Marriage is intended by God to be a thriving, lifelong relationship between a man and a woman enduring through trials, sickness, financial crises and emotional stresses. Therefore, Christians are called to defend and protect God's marriage design and to minister in Christ's name to those who suffer the consequences of its brokenness.
Please note that legal separation or divorce does not inherently disqualify a professional from CCN membership; however, we want to confirm that the individuals we refer to align in both belief and personal practice with Focus on the Family’s view of marriage and the biblical justifications for divorce. See link here to read Focus’s position statement on marriage and divorce. Please indicate whether you affirm Focus’s biblical stance on marriage and divorce as a Christian practitioner.
If your marital status has changed due to legal separation or divorce, or you are remarried please briefly state your personal circumstances in the space directly below.
The Value of ChildrenWe believe that children are a heritage from God and a blessing from His hand. Parents are therefore accountable to Him for raising, shaping and preparing them for a life of service to His Kingdom and to humanity.
Sanctity of Human LifeWe believe that human beings are created by God in His image. Therefore every person, from conception to natural death, possesses inherent dignity and immeasurable worth - including preborn children, elderly individuals, those with special needs and others marginalized by society. Christians, then, are called to defend, protect, and value all human life.
The Importance of Social ResponsibilityWe believe that God has ordained the social institutions of family, church, and government for the benefit of mankind and as a reflection of His divine nature. Therefore, Christians are called to support these institutions, according to God's design and purpose, and to protect them against destructive social influences. Such involvement is in obedience to Christ's lordship over all creation and is required by His command to care for the well-being of all people.
The Value of Male and Female
We believe that God created humans in His image, intentionally and immutably male and female, each bringing unique and complementary qualities to sexuality and relationships. Sexuality is a glorious gift from God to be offered back to Him either in marriage for procreation, union, and mutual delight or in celibacy for undivided devotion to Christ. Christians are called to proclaim the truth and beauty of God’s design and the redemption of sexual brokenness in our lives and culture through Jesus Christ.*
Focus on the Family Statement of FaithWe believe the Bible to be the inspired, the only infallible, authoritative Word of God;
We believe that there is one God, eternally existent in three persons: Father, Son, and Holy Spirit;
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;
We believe that for the salvation of lost and sinful humanity, regeneration by the Holy Spirit through faith in Jesus Christ is absolutely essential;
We believe in the present ministry of the Holy Spirit by whose indwelling the Christian is enabled to live a godly life;
We believe in the resurrection of both the saved and the lost: they who are saved unto the resurrection of life and they who are lost unto the resurrection of damnation;
We believe in the spiritual unity of believers in our Lord Jesus Christ.
The Statement of Faith does not exhaust the extent of our beliefs. The Bible itself, as the inspired and infallible Word of God that speaks with final authority concerning truth, morality, and the proper conduct of mankind, is the sole and final source of all that we believe.
To view our vision, mission and values as shared with the public on our website we welcome you to visit http://www.focusonthefamily.com/about/foundational-values
*If there are any changes to your state license, official certifications, and/or insurance information, please send updated documentation via e-mail to [email protected] or by fax to 719-548-4643.
After you click “Submit” you will see instructions on how to make your payment to finalize your renewal process.
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