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Revitalize Love Retreat
We would like to get to know you a little better before we meet at the Retreat!
Please fill out this form in order for us to better serve you, and hopefully meet your dietary restrictions and preferences.
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Email
*
Your email
Husband's (full) Name:
*
Your answer
Wife's (full) Name:
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Your answer
Cell Number:
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Your answer
Your Wedding Anniversary:
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MM
/
DD
/
YYYY
How many Children do you have together, or all together?
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Your answer
Are you a blended Family?
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Yes
No
Other:
Please rate your relationship On a scale of 1-5 and where you feel you are at currently?
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1. Terrible, and we need help asap!
2. We have a lot of conflict, and I often feel like giving up...
3. We could definitely use some relationship guidance... but, overall, I think we are doing ok.
4. We are on cruise control, and things going A OKAY... Could be better, but we aren't drowning.
5. We are doing great, being intentional, loving, kind, and understanding in every area of our relationship.
Other:
What do you feel is the greatest need in your marriage right now?
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Your answer
What do you hope to get out of is retreat?
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Your answer
Do either of you have any dietary restrictions or allergies?
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Your answer
What are some of your Favorite foods?
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Your answer
And your Not so favorite foods?
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Your answer
We want to know about upcoming retreats and couple's small group events:
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Yes please...
No Thanks...
Other:
Send me a copy of my responses.
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