Your Personal Profile - Agape Premarital Counseling

Agape Pre-Marital Counseling Services

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Your Personal Profile

Personal Profile Form

If you have decided to take the next step in the process of pre-marital counseling with us, we would like to use this "Personal Profile" to learn a little more about you and your fiancé.

Please take your time filling this form out and please complete it as accurately as possible. Once you complete and submit this form it will be kept in the strictest confidence and reviewed only by Todd LaVine. After it has been reviewed we will call to schedule a time for our live interview process. Please remember that at this point there is still no cost or obligation.

This interview process will ensure that both parties feel that this relationship is a good fit. If you would like to proceed from there, we will set a day and time to begin your pre-marital counseling.

First Name:	Bride Information
Last Name:
Address Street 1:
Address Street 2:
City:
State:
Zip Code:	(5 digits)
Daytime Phone:
Evening Phone:
Email:
Date of Birth:
Occupation:
Married before:
Do you have children:
Do you agree to abstain prior to the wedding:
Do you agree not to live together prior to the wedding:
Are you involved in a local church:
Are you a born again Christian:
Date of your conversion:
Please write your brief testimony:
Your Pastors name:
Your Pastors phone number:
Your Pastors email address:
Any other questions or concerns:
First Name:	Groom Information
Last Name:
Address Street 1:
Address Street 2:
City:
State:
Zip Code:	(5 digits)
Daytime Phone:
Evening Phone:
Email:
Date of Birth:
Occupation:
Married before:
Do you have children:
Do you agree to abstain prior to the wedding:
Do you agree not to live together prior to the wedding:
Are you involved in a local church:
Are you a born again Christian:
Date of your conversion:
Please write your brief testimony:
Your Pastors name:
Your Pastors phone number:
Your Pastors email address:
Any other questions or concerns: