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Spring 24 Questionnaire & Registration
Please complete the questionnaire for participation in the current semester of Re|Engage
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* Indicates required question
Husband FIRST & LAST NAME
*
Your answer
Wife FIRST & LAST NAME
*
Your answer
Times Married -- Husband
*
1st marriage
2nd marriage
3rd + marriage
Required
Times Married -- Wife
*
1st marriage
2nd marriage
3rd + marriage
Required
Anniversary Date
*
MM
/
DD
/
YYYY
His Birthday
*
MM
/
DD
/
YYYY
Her Birthday
*
MM
/
DD
/
YYYY
Husband's Marriage Satisfaction Score
*
Honestly rate your marriage on a scale of 1 - 10 (10 being highest)
marriage couldn't be worse
1
2
3
4
5
6
7
8
9
10
marriage couldn't be better
Wife's Marriage Satisfaction Score
*
Honestly rate your marriage on a scale of 1 - 10 (10 being highest)
marriage couldn't be worse
1
2
3
4
5
6
7
8
9
10
marriage couldn't be better
His Cell
*
Please enter his cell phone number
Your answer
Her Cell
*
Please enter her cell phone number
Your answer
His Email
*
Please enter his email address
Your answer
Her Email
*
Please enter her email address
Your answer
KIDS YOU’RE BRINGING:
*
Please list the names (and ages/grades) of all kids you will bring with you on Wednesdays--all children will attend age-appropriate programming provided for them in their ministry areas.
Your answer
Church Name
*
Please enter the name of the church you consider to be your church home
Your answer
Church Attendance
*
Please indicate how often you attend church
Choose
NA / Never attend
Seldom attend
Regularly attend
Submit
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