Your full name:
Why no work?
Name of Spouse:
Highest Level of Education:
What is your affiliation with Valley Life Church?
I am not a regular attenderI am a regular attenderI am a member
If you are a regular member/attendee at Valley Life, how long have you been attending?
If you do not attend Valley Life Church, do you have another church home?
How would you describe the current state of your marriage?
Why do you want marriage mentoring?
How long have you know each other?
How long have you been dating?
How long have you been officially engaged?
What is your tentative wedding date?
Where will the wedding be?
Check the answer below that best describes you
Seeker/not yet a Christ followerNew ChristianCommitted ChristianDo not believe in JesusI am not sure what I believe
How long have you been married to your current spouse?
Have you been previously married?
How many times have you been married?
How long were you previously married?
When was the divorce final?
What was the reason for the divorce?
Did you try to reconcile?
Who filed for divorce?
Did your spouse commit adultery?
Did you commit adultery?
Name & Age
Parent: BothWife onlyHusband only
Were you a Christian at that time?
Was your spouse a Christian?
I understand that the Mentor Couple we meet with are not professional counselors, but rather marriage mentors who agree to help us strengthen our marriage. I understand that we are responsible for the success of our own marriage and
do not hold our Mentor Couple or Dare to be Different responsible for the state of our marriage throughout the mentoring sessions or any time thereafter. I understand that the Mentor Couple can discontinue the mentoring at any time and that the fee paid for mentoring is nonrefundable.
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