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Conquerors Church
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Name
(
Required
)
Email Address
(
Required
)
Personal Information
Registers Name (
Required
)
Spouse's Name
Gender (
Required
)
Female
Male
Mobile Phone (
Required
)
Email: (
Required
)
Relationship Status
Are you registering as individual or couple? (
Required
)
individual
couple
Martial Status (
Required
)
Single
Dating
Engaged
Married
Separated
Divorced
If married, how long have you been married?
If engaged, when is your wedding date?
If dating how long have you been in relationship?
Do you have children? (
Required
)
Yes
No
If so how many? And what are their ages?
Faith & Church Involvement
Are you a member of Conquerors Church? (
Required
)
Yes
No
If not, do you attend church regularly, attend another church? If so, which one? (
Required
)
How would you describe your personal faith journey? (
Required
)
Is your spouse/partner actively in a church? (
Required
)
Yes
No
Coaching Expectations
What are the main reasons you are seeking relationship coaching? (
Required
)
Premarital Counseling
Marriage Enrichment
Conflict Resolution
Communication Improvement
Trust Rebuilding
Parenting Challenges
Other, specify
Have you attended relationship counseling/coaching before? If yes, where and when? (
Required
)
What specific goals or outcomes do you hope to achieve through coaching?
What are your main strengths in your relationship?
What are the primary challenges or concerns in your relationship?
Scheduling & Confidentiality
What date and times are you available for coaching sessions?
Are you open to group coaching sessions or prefer one-on-one coaching?
Do you agree to keep coaching discussions confidential and respect the guidance provided?
Yes
No
Final Acknowledgement
Do you understand that relationship coaching at Conquerors Church is faith-based and guided by biblical principles?
Yes
No
Do you agree to actively participate and implement strategies discussed in coaching sessions?
Yes
No
Any additional comments or questions?
Submit
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