Mending The Soul: Intake Form

Mending The Soul: Intake Form

Which class would you like to sign up for? (Class occurs weekly for 8-12 weeks)
Do you need childcare?
Please provide name and age.

Number of years married (if applicable)
Does your spouse know you want to participate in a group? (required)

Which ones and for what purpose?

Please describe.

Please explain.

Please explain.

Please describe.

How is it being treated? Do you see any reason why this condition would interfere with your ability to concentrate on the workbook material required for this group?

Please Explain.

List number of years, purpose, and approximate number of sessions.

What church?