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Added: 4/23/2024

APPLICATION FOR COUPLES COACHING

Thank you so much for your interest in Venture Coaching, From time to time we all get "stuck", life is full of challenges and concerns, it is helpful to have someone guide us through the truth from God's Word, find freedom and gain a new perspective. Venture coaches are trained, authorized and gifted men and women who walk beside you through 6 one hour coaching sessions. This application will help us know you better and determine if coaching is the right fit for you

MALE

First Name

First Name is required.

Last Name

Last Name is required.

Birth Date

Birth Date is required.

Occupation

Address

Work Phone

Cell Phone

Email

Email address is not valid

Email is required.

FEMALE

First Name

First Name is required.

Last Name

Last Name is required.

Birth Date

Birth Date is required.

Occupation

Address

Work Phone

Cell Phone

Email

Email address is not valid

Email is required.

CHURCH INFORMATION

Do you regularly attend church?

Do you regularly attend church? is required.

Are you involved in any other groups, classes, or serving ministries? If so, please list them.

How did you hear about our Biblical Life Coaching Ministry?

How did you hear about our Biblical Life Coaching Ministry? is required.

If Other, please explain

COACHING ISSUES/CONCERNS

What is the concern that motivated you to request coaching?

What is the concern that motivated you to request coaching? is required.

Have you received coaching for this particular issue before from a pastor or other coach?

Have you received coaching for this particular issue before from a pastor or other coach? is required.

Are there any other issues or information you think we should know?

What are you expecting or hoping to receive from Venture Biblical Life Coaching?

What are you expecting or hoping to receive from Venture Biblical Life Coaching? is required.

Briefly describe your relationship with God:

Briefly describe your relationship with God: is required.

MARRIAGE AND FAMILY INFORMATION

Have either of you been previously married?

Male:

Female:

If yes, briefly explain

Have you attended premarital counseling?

Have you ever been separated?

Are you separated now?

Do you have children?

Tell us about the type of home you grew up in:

To help us better understand and serve you, please check all statements below that are true for your relational history

We married later in life (40 years or older) We married young (under 20 years of age) This is a second marriage We have a large family (4 or more children) We are / have a blended family We have a special-needs child We have experienced the loss of a child We have / are experiencing infertility We have unusually long work hours We are struggling with unemployment We both work outside the home We have to negotiate a demanding travel schedule We have difficult in-law relationships and interference We have/are struggling with a serious illness We have/are struggling with sexual intimacy We have/are struggling with sexual issues and addictions We have/are struggling with sexual infidelity We have/are struggling with financial crisis One of us is dealing with a mental disorder We have/are struggling with opposing faith backgrounds We have/are struggling opposing values and choices We were raised with extremely different cultural backgrounds We have/are struggling with little to no love or respect We have/are struggling with little to no communication We have/are struggling with little to no spiritual connection We have/are struggling with little to no time together We have/are struggling with little to no trust We have/are struggling with anger and fighting We have/are struggling with fear and anxiety We have/are struggling with isolation and loneliness

Other - Please Specify

Typing our names below and returning this form electronically will be deemed as an acceptable form of signature verification

Typing our names below and returning this form electronically will be deemed as an acceptable form of signature verification is required.

CONSENT

Biblical Basis:

Venture believes that the Bible provides thorough guidance and instruction for faith and life. We believe the Bible is God’s all-sufficient guide for relational living. Therefore, our short-term guidance is based on Scriptural principles that are supported by practical guidance. Coaches at Venture are not licensed as therapists or mental health professionals, but are trained leaders who can provide solid Biblical guidance.

Confidentiality:

Confidentiality is an important aspect of the coaching process, and we will carefully guard the information you entrust to us. Please be assured that our coaches do not disclose personal information to others, They will make every effort to help you find ways to resolve a problem privately . However, it is important for you to understand that there are certain circumstances where it may be necessary for us to share information with others.

When a Coach seeks guidance and/or supervision from the Director of Coaching.
Where a California law dictates
1. Child abuse
2. Elder abuse

Agreement:

By signing this consent, you acknowledge and agree:

That you have read this Consent Form and agree to abide by the principles and policies of the Venture Biblical Life Coaching Ministry as outlined above.
That you are seeking, and Venture is providing Biblical Life Coaching. Venture has informed you that it does not and will not provide any form of professional mental health coaching.
That you will not attempt to subpoena or require any Venture coach to appear in any legal proceeding related to any matters discussed during coaching; nor will you attempt to subpoena any notes or records related to this coaching.

Having clarified the principles and policies of our coaching ministry, we welcome the opportunity to minister to you in the name of Jesus Christ. We desire to be used by Him as He helps you to grow, mature and transform into the individual He wants you to become. If the principles and procedures outlined above are acceptable to you, please sign below.

Name (Please Print)

Name (Please Print) is required.

Signature

Signature is required.

Date

Date is required.

Submit

16845 Hicks Road
Los Gatos, CA 95032 408.997.4600

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