Victory in the Vow

Marriage Ministry

 

 

NAME Request for Marriage Mentoring

 

Note: Husband and wife must complete one form each.

 

Full Name *
First Name
Middle
Last Name
Is this your first marriage?*
How long have you been married?*
Spouse Name:
First Name
Middle
Last Name
Street Address: *
Address Line 1
Address Line 2
City
State/Prov.
Postal Code
Home Phone:*
Email:*
Cell Phone*
Number of Children:*
Ages of Children: *
Are you a partner of VICCC?*
Non-Partners are required to obtain a letter from their Pastor authorizing counseling.
If yes, how long?*
Are you a member of a small group?*
If yes, Group Name?*
Are you saved?*
How long?*
Have you attended any marriage events/workshops?*
If yes, name of event/workshop?*
SUMMARY OF REASON (S) FOR REQUESTING MARRIAGE MENTORING
What is the nature of your request? *
How long have you had this problem? *
What have you done about this problem? *
What would you like to happen? *
DISCLAIMER AND SIGNATURE
I voluntarily agree to the Noutheic (Biblical) counsel that may be provided to me by Victory in Christ Christian Center CMS Team. I understand and recognize that such great guidance comes from God. I acknowledge that I take full responsibility for all decisions made by me during and after this session.
Initials*

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