Growing Your Marriage
Application for Virtual Workshop

  • If you would like to select multiple options, click Ctrl or Command on your keyboard and select each desired option.
  • Date Format: MM slash DD slash YYYY
  • Date Format: MM slash DD slash YYYY
  • I give my consent that the information provided at registration may be communicated to facilitators for the purpose of equipping to provide the best care and assistance possible. I release Growing Your Marriage, its directors, leaders and volunteers, from all actions, damages, or personal injuries which may occur to me or a member of my family. I understand that in the event of a minor injury, I, or a member of my family may receive first aid treatment. I will be informed as soon as possible of any injury or condition of one of my family members and will be responsible thereafter for their care. In the event of an emergency, injury, or illness, emergency medical services and I will decide the best course of action. If the leaders are unable to reach me, I authorize them to take whatever action is necessary for the safety and health of my family members. I understand that in order for everyone to experience a sense of calm and peaceful relaxation, Growing Your Marriage events are drug free and tobacco free. Use of cell phones is discouraged. By checking the boxes below you are agreeing on behalf of your family to an electronic signature.