Marriage Mentoring Request Form

By submitting, you both agree and understand that the Mentor Couple you meet with are not professional counselors, but volunteer marriage mentors who agree to share their life experiences with you to help you strengthen your marriage. You both agree and understand that you are responsible for the success or your marriage. Since we are not claiming to provide counseling, you agree to not hold our Mentor Couple responsible for the state of your marriage throughout the mentoring sessions or any time thereafter. The information contained in this request form will be used by church leaders and will not be shared at any time with other parties.

Your name *

Email address *

Address *

Phone number *

Birthdate *

Anniversary date *

Do you attend Discovery Church? *

Why are you requesting a marriage mentor couple? *

Choose one.

Our marriage is good, but could use some improvement.

Our marriage is struggling and in need of help.

Our marriage is in crisis, and we are in need of urgent help.

Premarital

Have either of you been married before? *

Wife: yes

Husband: yes

Both

Has anyone had an affair? *

Is there mental illness involved? *

Does anyone have a severe addiction? If yes, please explain.

Please add your Spouses' information and any children that you may have.

Household members

A copy of your responses will be sent to your email address.