Application Form

It is easier than ever to apply for a program of recovery at the Noupoort Christian Care Center. All you need to do is follow these steps.

  • Download the application form found below.
  • Print out the form and fill in all the required details
  • You can either fax the form back to us on 049 843 1873 or you can scan and email it to us at
  • We will then contact to notify you of the approval of your application. The rest of the details will then be explained to you by our trained consultant.

Please don’t hestiate to contact us if you have any queries, our contact details are available here

Application Form Download

Click the link below to download our application form.



Feel free to contact us regarding any queries you might have. Noupoort Christian Care Center is here to help you through any addiction related issues, phone now to speak to one of our trained consultants. Comments or questions are welcome.

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