Discovery! Program Registration

		Program month you will be attending:

	First Name:	Class#:

	Last Name:	Home Phone:

	Address:	Work Phone:

	City:	Cell Phone:

	State:	Email:

	Zip:	Marital Status:

	Age:	DOB:

	Emergency Contact Name & Phone Number:

	Referred By:	Occupation:

	Month/Year Attended D1	Month/Year Attended D2

	Month/Year Attended D3-Mission	Month/Year Attended Refocus

	Month/Year Attended Spiritual	Is this your first time attending Relationship?

	1. What do you want to get out of Discovery! Relationship?

	2. How long have you been in your relationship?

	3. How did you meet your partner and what attracted you to them?

	4. Does this relationship have patterns that are similar to your childhood or any previous relationship in your life? Explain.

	5. Describe a significant emotional milestone within your relationship.

	6. What are the strengths within the relationship?

	7. What are the weaknesses within the relationship?

	8. Are there any stress points within the relationship? Explain.

	9. List 1 song that describes the way you feel about your partner. Explain.


A successful submission will take you to the Payment page.