The Empowerment Resurrection Center of New Jersey, located in Bridgeton, New Jersey, is a drug and alcohol addiction assistance and rehabilitation organization, accepting clients from the New Jersey, Pennsylvania and Delaware tri-state area and beyond.

Formally Faith Farm Recovery Addiction Center

ERC-NJ provides the only adult, long-term residential drug and alcohol program
in the  New Jersey, Pennsylvania and Delaware tri-state area.



21 Stretch Road

Bridgeton, NJ 08302-9295


Office: 856.575.0500 
Fax: 856.575.0505

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Pre-admission Application Form

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Applicants FULL Name

       Ex. First, Middle, Last


Applicants Address 


Applicants City                             State                       Zip 


Applicants County


Applicants Home Phone 


Applicants Cell Phone 


Applicants Work Phone


Applicants Email


Applicants Date of birth (must be 18 years old)
   Ex. July 10, 1981


Level of Education ( Check ALL that apply.)
   No GED or High School  GED  High School Diploma  Vo-tech College Degree


Are you currently employed?
     Yes      No


Marital status 
     Single    Married    Separated     Divorced


Current Legal Problem(s), if any 

    Briefly Describe - If more space is needed continue typing.


Do you have Health Insurance?
  Yes   No


If YES, Name of Health Care  Provider 



How were or who you referred to our program? 



First Drug of Choice                      Route of Administration



Second Drug of Choice                  Route of Administration





Emergency Contacts FULL Name 


Emergency Contact Address


Emergency Contact City              State                      Zip


Emergency Contact Phone

Emergency Contact Cell Phone

Emergency Contact E-mail


Other Information

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501 non-profit organization

So then faith cometh by hearing,
& hearing by the word of God.
                                    - Romans 10:17