First Name

Last Name

Email *

Phone *

Spouses Full Name

How long have you been married?

Do you have any children?

Yes

No

If YES, how many and what ages?

ARE YOU BOTH READY?

Transformation Requires Two People Willing to Show Up

How would you describe the current state of your marriage?

We're doing well, but we want to become even stronger.

We love each other, but we've become disconnected.

We keep getting caught in the same arguments or patterns.

There is unresolved hurt affecting our relationship.

Our marriage is struggling significantly.

We are seriously considering separation or divorce.

We are currently separated.

On a scale of 1–10, how connected do you currently feel to your spouse?

What are the biggest challenges in your marriage right now?

What have you already tried to improve your marriage?

Is there unresolved pain from the past that continues to affect your relationship today?

Yes

No

Not sure

Briefly tell us what continues to come up.

WHAT DO YOU WANT?

What Would Change Everything?

If this retreat could create a meaningful shift in your marriage, what would you most want to be different when you leave?

What would becoming stronger as a couple mean for your marriage, your family, and your future?

Why is working on your marriage important to you right now?

ARE YOU BOTH READY?

Transformation Requires Two People Willing to Show Up

Are both you and your spouse aware that you're applying for this retreat?

Yes

No

I haven't talked with my spouse about it yet.

How willing are YOU to look honestly at your own patterns and take responsibility for your part in the relationship?

Completely willing

Willing, although I know it may be uncomfortable

I'm unsure

I'm mostly hoping my spouse will change

Are you both willing to participate fully in conversations, exercises, and experiences during the retreat?

Yes

No

We need more information

Christian Foundation & Safety

Before we invite a couple into an intensive experience, there are a few things we need to understand.

The Biology of Marriage Couples Retreat is built upon a Christian foundation and honors marriage as a sacred covenant. Are you comfortable participating in an experience where faith and Christian principles are part of the retreat?

Yes

No

I'd like to understand more before deciding.

Are either of you currently experiencing any of the following?

Please Explain

Is there anything happening in your marriage that you believe we should know before determining whether this retreat is appropriate for you?

Investment

If accepted, are you financially prepared to make this investment of $3333 in your marriage?

Yes, we are ready to move forward.

Yes, but we would prefer a payment option if available.

We need to discuss the investment together.

Not at this time.

Why do you believe your marriage is worth fighting for?

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