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Restore Application
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Restore
First Name
Last Name
Email
Mobile Phone
Birth Date
Group Commitment: Because Restore is a group experience, consistent attendance is required. You must be present for the first 4 weeks, when we share our stories. In the remaining weeks, you can miss a maximum of two weeks due to extenuating circumstances. Can you commit to these attendance requirements? If you select No, please be sure to share details in the comments section at the end of the application.
Yes
No
Gender
Male
Female
Marital Status
Single
Married
If married, what is your date of marriage?
Are you a member of Midtown?
Member
Member in process
Attender
If you are in a community group, who are your group leaders?
If married, do you plan to participate in a couples' group?
Yes
No
I don't know
Why do you want to participate in a Restore group?
Given your reasons stated above, share 1-2 specific issues or areas of life that you want to address with the gospel.
Please rate the severity of your present concerns.
Crisis (highest)
Severe
Moderate
Mild (lowest)
Please write a one-paragraph description explaining the issues or areas of life you want to address during your time in Restore.
What is most encouraging about your life with God and others?
What is most challenging about your life with God and others?
Do we have your permission to share this information with the appropriate ministry leaders to arrange for the best possible care?
Yes
No
After you complete Restore—in order to provide continuity in your care and development, do we have your permission to share relevant information from your Restore experience with appropriate ministry leaders?
Yes
No
Do you have any learning disabilities, medical conditions, or other diagnosis that we should know about so that we may best care for you during this experience? (If yes, please explain under "Comments" below.)
Yes
No
Comments
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