Form
Name
*
First Name
Last Name
Email
*
example@example.com
Shipping/ mailing Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Date of birth
-
Month
-
Day
Year
Date
Do you believe in God?
Yes
No
I am not sure
Do you believe in Jesus Christ?
Yes
No
I am not sure
Why do you want to develop your relationship with God?
*
To enter Heaven
To get delivered
To get saved
For peace
To be genuinely happy
Because I am scared
I want to change as a person
For growth
none of the above
If none of the above, please explain.
Are you saved?
*
Yes
No
Not sure what it means to be saved
I have said the sinner’s prayer
Have you been baptized?
*
Yes
No
Not yet
I wish to be
Do you own a Bible?
*
I used to
Yes I do
Not really
No I don’t
I have it on my phone
Which version of the Bible do you read?
King James
New International Version
Amplified
New Living Translation
Do you understand what you read in the Bible?
Yes I do
Not really
A little
No I don’t
How often do you read the Bible?
Once daily
Twice daily
Twice a week
Once a week
once a month
I only read the morning verse on the app
Do you pray?
Yes
No
Not much
Sometimes
How often do you pray?
Once daily
I talk to God through out the day
When I remember
I constantly pray
I know I dont pray enough
Which areas would you say you need help the most? (Choose multiple answers)
*
Setting aside time to read the Bible
Understanding the Bible
Learning how to pray
Abstaining from sex
struggling with sin/s
Faith
Cursing
Waiting for marriage
Explain all that you want me to help you with! The more you write, the more I understand. So don’t worry just pour it out! ❤️ Once you click submit you will be redirected to a private Facebook group! See you soon! 😊
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