Care & Support Form | Need A Coach

The Life Church Care & Support

The Life Church is committed to helping people grow and receive care and support through Life Groups and our Care & Support ministries. Please tell us more about you and your current need, so we can provide the best care and support possible.
By filling out this form, you give The Life Church permission to share your information with appropriate team members. Your responses will be kept confidential.

*Financial Coaching has been paused for the remainder of 2022. Please check back in 2023 for it to resume.
Your Name*

First NameLast Name
Your Email*
example@example.com
Your Phone Number*

Area CodePhone Number
Your Address*

Street Address

Street Address 2

CityState

Zip Code
Your Gender: *
Which type of coaching are you requesting?*
Which area of Marriage Coaching do you need most help in?*
Which area of Home Coaching do you need most help in?*
Which area of Financial Coaching do you need most help in?*
Which area of Soul Coaching do you need most help in?*
Which Life Church location do you currently attend?*
Are you a part of a Life Group?*

YesNo
If yes, who is your Life Group Leader?*
Have you completed Discovery?*

YesNo
If yes, what team are you currently serving on?*

Funeral Service
Thank you for reaching out. We are so sorry to hear about your loss. Please submit your information and a member of our Care & Support team will reach out as soon as possible.

In the meantime, if there are any questions, please reach out to Pastor Matt Anzivino directly by phone 901.602.7240 or email matt@thelifechurch.com.

Sincerely,
Matt Anzivino
Care & Support Pastor

Hospital Visit
Name of the person in Hospital:*
Name of the Hospital:*
Hospital Room Number:*
Why is the person requesting a visit in the hospital? *
(Accident, procedure etc.)
What is the current status of the person requesting visit? *
(Critical, Stable etc.)

Parenting or Family Coaching
Your Name*

First NameLast Name
Name of Parent/ Legal Guardian*

First NameLast Name
Relation to the Child*
Child's Name*

First NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Child's Gender*

FemaleMale
Who does the child live with? *
(Parents, Step Parents, Grandparents, Siblings, etc.)
Does the child attend school?*

YesNo
If yes, what grade/ year?*

Parenting or Family Coaching

(Page 2/3)
Tell us a little about your child. *
Does he/she have any interests or hobbies? What are his/her positive characteristics?
What is the primary reason for your concern?*
Does your child share your concerns? Why or why not?*
Is there a concern of abuse or a history of abuse, either physical, mental, emotional, sexual or other?*

YesNo
If yes, please explain.*

Premarital Coaching
Thank you for your interest in premarital coaching. Please click "Submit" below so we can receive your initial information.

Your next step will be to visit the "Weddings at The Life Church" webpage, read over the information and register for premarital education using the button at the bottom of the page.

In the meantime, if you have any questions, please reach out to our Wedding Coordinator, Ashley Pier. Congratulations on your engagement and we look forward to connecting with you!

Other
Please give a brief description of your current need:*
If required, what days and times are you available to meet?

Counseling/ Coaching History
Have you received counseling/coaching before?*

YesNo
If yes, who facilitated the counseling/coaching?*
When did the coaching take place?*
What were the results?
By filling out this form and clicking "Submit" below, I give The Life Church Memphis permission to share my information with appropriate staff members. I recognize that all information will be otherwise kept confidential.*

I acknowledge the above

Your Consent
By completing and submitting The Life Church Care & Support form, you are stating that you, the (Coachee/Client) have read the given ministry agreement, understand it, and agree to the terms herein written.
- The Life Church Care & Support is a church-based ministry of The Life Church providing coaching and prayer ministry in individual and group settings. Our coaching is done by the pastoral staff and lay ministers herein referred to as “coaches.” These individuals are not licensed as professional counselors, social workers, or psychologists because they perform religious coaching and not secular or psychological counseling. If it becomes apparent that secular or psychological counseling may better address the coachee’s needs, the coach will immediately initiate the referral process to a licensed professional counselor, social worker, or psychologist.
- Under all circumstances, sexual contact between a coach and coachee is prohibited. If any coach suggests or attempts sexual advances, the coachee shall terminate the session immediately and report the incident to the Executive Pastor OR any other Pastor not involved in the coaching.
- Under normal circumstances, your coach will use their good faith efforts to keep your discussions in confidence. However, you should be aware there are some situations in which your coach may be required by law to report information to the proper authorities without your permission or knowledge. These situations include, but may not be limited to: a coachee’s intent of harm to self or others, involvement in a felony, suicidal intentions, and/or reasonable expectation of child or elder abuse or neglect. Your coach may also disclose information in response to a subpoena issued by a court of law. Additionally, if you occupy a leadership or ministry staff position, your coach may also disclose information to the person in authority over you, in the event he or she deems it relevant to your fitness or ability to fulfill your position.
- Officially recognized church staff and lay personnel may also have access to your pastoral file. Any other person seeking access to your file may do so only with your written and or verbal permission. While The Life Church cannot guarantee complete confidentiality concerning the information we receive from you, we will make every effort to do so.
- The Life Church requires that parent(s) must be actively involved in any coaching and/or ministry that is extended to a minor child as determined by the coach. At the discretion of the coach, parent(s) will be required to make themselves accountable for active participation in coaching and/or ministry offered by The Life Church.
- Coachee’s with any concerns or questions about this agreement agree to raise them with their coach at the earliest possible time.
- This agreement herein referred to as the “ministry agreement,” will govern all relations involved during the term of the coaching process. Should the coachee participate in ministry, the Voluntary Release, Assumption of Risk, and Indemnity Agreement will be incorporated as part of this ministry agreement. It is agreed that any disputed or modifications of this ministry agreement will be determined directly between the individuals involved. If this ministry agreement is not satisfactory, then it is further agreed that disputes and disagreements will be taken to the The Life Church Board of Overseers for mediation. If a satisfactory resolution is not achieved, then it is further agreed that a mutually acceptable third-party mediator will be utilized. If the mediation is unsuccessful, then the dispute shall be submitted to Christian Arbitration under Rules of Arbitration published by the Institute for Christian Meditation, www.hispeace.org. All expenses incurred will be the responsibility of the party bringing the dispute.
To submit your application for coaching, please agree to the consent terms above.*

I have read and agree to the consent terms above.
Should be Empty:

The Life Church Care & Support

Life Coaching

Financial Coaching

Funeral Service

Grief/Loss

Hospital Visit

Parenting or Family Coaching

Parenting or Family Coaching

Parenting or Family Coaching

Premarital Coaching

Marriage Coaching

Other

Counseling/ Coaching History

Your Consent