Marriage & Parent Mentoring Inquiry

This form is for anyone who is interested in getting a marriage mentor couple to meet with you and your spouse about your marriage. All the information you provide will be viewed by the ministry coordinator, Becca Nelson, who will then set up a meeting between you and your mentors. This form will be forwarded on to your matched mentors.

Your name *

Last name

Email address *

Phone number *

Phone type

Do you attend a Lifegroup? If so, which one? *

Does your spouse want to participate in marriage mentoring as well? *

Yes

I do not know

What type of help do you believe your marriage needs? *

A marriage "Check Up" to get an outside perspective of how we are doing.

Some consistent help (3-5 meetings).

Long term help.

I don't know and this is why I am reaching out.

How long have you been married? *

What kind of challenges have you been facing in your marriage? *

Check all that apply

Communication

Emotional Connection

Finances

Conflict Resolution

Physical Intimacy

Parenting Styles

Habitual Sin: Drug use, excessive alcohol use, pornography & masturbation, other sexual immorality

Infidelity

I would rather not communicate any of this in this form, but would be happy to in person.

Is there anything that you could write to help us assess the level of support and expertise we should provide? *

I understand that the marriage mentors are volunteers and not professional counselors. *

Yes, I understand.

I need more information.

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Antioch Houston
info@antiochhouston.com
281-947-8975

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