BecomingONE Marriage Information Form

Thank you for your interest in learning more about the Agape Child & Family Services Becoming ONE Marriage Enrichment and Relationship Skills Education Program. Here is a synposis of what to expect:

a) Orientation about Becoming ONE and the Prep 8.0 curriculum which is a 16 hour program where couples learn tools to enrich their relationship.

Modules include:

1) The Three Keys to Success; 2) Personality; 3) Danger Signs & Time Out; 4) Anger & Stress; 5) The Speaker Listener Technique; 6) Events, Issues & Hidden Issues; 7) Fun & Friendship; 8) Commitment 9) Money Smart Financial Literacy

b) Enrollment in program by completing the Charactertistic & Entrance Survey, Prepare & Enrich Assessment, Money Smart Assesstment, Evaluation, and an Exit Survey. Married couples who complete the program are eligible to receive incentives in the form of gift cards of over $150 per couple!

c) Attend BecomingONE local workshop or retreat!
Information Form
Have you already gone through the Becoming ONE Program?*

YesNo
Husband's Name*

First NameMiddle NameLast Name
Husband's Birth Date*

MonthDayYear
Wife's Name*

First NameMiddle NameLast Name
Wife's Birth Date*

MonthDayYear
Wedding Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Husband's E-mail*
example@example.com
Husband's Phone number*
Wife's E-mail*
example@example.com
Wife's Phone Number*
Referring Organization*
Are You a Pastor, Minister, Chaplain, or Serve in Ministry at a Church or Faith Based Organization?*
If Yes, Please Specify Your Role*
Which series of programming do you prefer to attend?*

Weekly 1.5hr2 Day Conference2 Full Days Saturday (Back to Back)2 Full Days Saturday (Bi-Weekly)Zoom only (evening Sessions)
Husband's T-shirt Size
Wife's T-shirt Size
I understand that meals are provided, however, the venue cannot accommodate individual dietary requirements.*

Yes, I understand
Couple's Favorite Love Song and Artist *
By checking each box below, I AGREE to COMPLETE all the surveys to enroll in the Becoming One Program PRIOR TO THE START OF WORKSHOP. (You and your spouse will receive three $25 gift cards for COMPLETING the surveys and completion of the program.)*
Please Share Any Additional Information Needed
Please Note: PHOTOGRAPHS AND VIDEOS ARE TAKEN AT ALL OUR EVENTS.
Should be Empty:

Information Form

Please Note: PHOTOGRAPHS AND VIDEOS ARE TAKEN AT ALL OUR EVENTS.