Premarital ____ Initials _________
Married ____ Date ___________
Man’s Name _____________________________________________________Age __________
Women’s Name ___________________________________________________Age _________
Address:______________________________________________________________________
Phones: Home___________________________ M/W Work ___________________________M/W
Cells ________________________________M/W ________________________________M/W
Emails ________________________________M/W ________________________________M/W
How did you find out about us? ______________________________________________________
What prompted you to request Coaching? ______________________________________________
How would you rate your relationship on a scale from 1 to 10 Man: ________ Woman__________
What are your expectations or objectives from coaching? Use back if necessary
Wedding Date: _______________________ Have You been married before? M _______ W _______
Children Information
Names Age Sex Names Age Sex 1.__________________________________ 3.___________________________________ 2.__________________________________ 4.___________________________________
Current Info
Are you currently engaged Yes__ No __ N/A Is it OK to leave messages? Yes____ No ____
Are you living together? Yes__ No __ Is pornography involved? Yes ____ No ____
Are drugs/alcohol involved? Yes __ No __ History of depression or mental health issues?
Yes____ No____
Mark One:
Protestant ____ Catholic ____ Jewish ____ Interfaith (two different faiths) ____ Non Believers ____
Someone who we could contact if we can’t get a hold of you: Name _________________________
Address: ________________________________________ Phone: _______________________
………………………………………………………………………………………………………………………
Price: Married coaching $160; Premarital call for details. Payment arrangements can be made upon request. Please contact MarriageTeam for details.
There is a money back guarantee. If you are not satisfied with your coaching experience
You will be given a refund if you request it in writing.
Return Coaching Agreement and this Application with a check or money order to:
MarriageTeam, P.O. Box 873086, Vancouver, WA 98687-3086
If you have questions, please call 360-450-6042
Be Sure to Complete the Couple Coaching Agreement ....................................................................................................................................................
Sent Agreement Link: _______ Agreement/Check recd _________ Coach Couple ________
Set up Inventory: ___________ Potential coach contacted ______ Start Coaching _______
Complete Inventory: ________ Coach Called _________________
Enter in Act: ______________ Coach Couple assigned ________
