Coaching Application

Request for Marriage Coaching

Please select what service/services you are applying for.*
If you would like to select multiple options, click Ctrl or Command on your keyboard and select each desired option.
Husband's/Groom's Information*
Title First Name Last Name
Date of Birth*
MM slash DD slash YYYY
Email*
Phone*
Wife's/Bride's Information*
Prefix First Last
Date of Birth*
MM slash DD slash YYYY
Email*
Phone*
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Emergency Contact (if attending an in person event)
Please list someone not attending with you in case of emergency.
First Last
Phone
Relationship to you
How long have you been married or engaged if this is premarital coaching?*
Have either of you been married previously?*
How is your Emotional Connection?*
How is your Physical Connection?*
How is your Spiritual Life and Connection?*
How would you rate your ability to communicate?*
What 3 things do you enjoy doing together?*
Briefly describe a core strength in your relationship.*
Briefly describe an area that needs attention in your relationship.*
What are your hopes & expectations for the weekend/workshop/study?*
Comments
How did you learn about Growing Your Marriage?*
Have you participated in a Growing Your Marriage event before?*
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 give my consent that photographs, interviews and audio/visual recordings made during the course of the event may be used by Growing Your Marriage for training, promotion, and fundraising. (in person events only - does not pertain to virtual studies and coaching) 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.
*
- I agree to the above terms