Wedding Information Sheet

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Mentor Request Form – Bride/Wife RETURN this form to the church along with the mentoring fee.

Date: ________________________ Name: __________________________________________________

Age:________________

Address: ___________________________________________________________________________ City: Home Phone:

State:

Zip: ______________________

Work Phone: _______________E-mail Address: ______________

Ethnic Origin: ____________________ Highest Level of Education:_______________________ Member/Regular Attendee at our church?  YES, How long_______________

 NO

If not, are you attending another church? ___________ Church Name__________________ Why do you want to be mentored? _________________________________________________

For Pre-Marital Only: How long have you known each other? _______________________________ How long have you been dating? _____________________________________ How long have you been officially engaged? __________________________ What is your tentative wedding date? _________________________________ Where will the wedding be? ___________________________________________

More About You Occupation: ______________________________________________________________________ Hobbies: __________________________________________________________________________ ___________________________________________________________________________________ Pet Peeves: _______________________________________________________________________ Strengths: _________________________________________________________________________ ___________________________________________________________________________________ Weaknesses: ______________________________________________________________________ Rev. 2009 ________________________________________________ Dare to be Different

Check the answer below that best describes you o o o o o

Seeker/not yet a Christ follower New Christian Committed Christian Agnostic I’m not sure what I believe

Marital Status How long have you been married to your current spouse? ____________________________ Have you been previously married? _______________ How many times? ________________ How long were you married? _______________When was the divorce final? _____________ What was the reason for the divorce? ________________________________________________ Did you try to reconcile? ________________ Who filed for divorce? _____________________ Did your spouse commit adultery? _______________ Did you commit adultery? __________ Were you a Christian at that time? ____________ Was your spouse a Christian? __________ Children?  YES

 NO If yes, names and ages of children:

Name

Age

Parents:  Both  Wife only  Husband only

Name

Age

Parents:  Both  Wife only  Husband only

Name

Age

Parents:  Both  Wife only  Husband only

Name

Age

Parents:  Both  Wife only  Husband only

Name

Age

Parents:  Both  Wife only  Husband only

MENTOREE AGREEMENT I, ________________________, understand that the Mentor Couple we meet with are not professional counselors, but volunteer marriage mentors who agree to share their life experiences with us in an effort to help us strengthen our marriage. I understand that we are responsible for the success of our own marriage and I do not hold our Mentor Couple responsible for the state of our marriage throughout the mentoring sessions or any time thereafter. I will allow Dare to be Different to access our personal information for private data collection only. All data collected by Dare to be Different will only be used as a quality control measure and will not be shared at any time with other parties. Please sign here:___________________________________________ Date: ________________

Rev. 2009 ________________________________________________ Dare to be Different