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Pure Heart Weekend
Speaking
Counseling
Sexual Stronghold Counseling
Pure Heart Weekend Registration
Pure Heart Weekend
Step
1
of
2
50%
Date you wish to attend:
MM slash DD slash YYYY
Name
First
Last
Age Range
*
75+
65-74
50-64
40-49
25-39
14-24
Email
Phone
Please check all that apply:
Single
Married
Number of divorces:
1. Briefly describe the beginning of your relationship with God:
2. Reflect on your childhood. Was it a safe and loving home you grew up in? (Explain in a little detail what it was like; what were your parents like? Did you want to parent like them?)
3.How old were you when life became more difficult? (Explain in a little detail “WHAT” changed)
*
4.Humanly speaking, if God showed up and said, “I want to help you out,” which of these do you feel He would have to do:
Heal an old wound?
Help feel forgiven?
Fix a broken heart?
Set you free from something?
(Explain in a little detail “WHAT” is the issue that needs His attention)
*
5. What has been your greatest achievement in life? (be “earthly;” Don’t tell that you gave birth to children or something God actually did. This is about what YOU actually did, by His grace. )
6. What has been your greatest frustration in life?
7. On a scale of 1 — 10 (highest), how would your rate the level of disappointment with yourself:
1
2
3
4
5
6
7
8
9
10
8. On a scale of 1 — 10 (highest), how would your rate the level of disappointment with your marriage:
1
2
3
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5
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7
8
9
10
9. On a scale of 1 — 10 (highest), how would your rate the level of disappointment with your spiritual life:
1
2
3
4
5
6
7
8
9
10
10. On a scale of 1 — 10 (highest),rate the level of anger with God:
1
2
3
4
5
6
7
8
9
10
11. On a scale of 1 — 10 (highest),rate the level of anger with yourself:
1
2
3
4
5
6
7
8
9
10
12. On a scale of 1 — 10 (highest),rate the level of anger with others:
1
2
3
4
5
6
7
8
9
10
13. What is the anger mostly about?
14. What has been (is) hurting you most in life? (something you did? Decisions you’ve made? Or something that happened to you? Or a way of behaving that you can’t quit? )
15. Does your past prevent you from enjoying life today? Why? (Please explain WHAT has happened, or didn’t happen, in the past in a little detail)
16. How would your family describe the following: They would say my good traits are . . .
17. They would say my bad traits are . . .
18. What do you think God desires more of from you? (please don’t say “time, Bible study, prayer” Be more specific in regard to conduct, character, actions, etc)
19. What do your loved ones need more of from you? (again, don’t say “time,” but if you gave more time to them WHAT do they need from you in terms of action, conduct, attitudes, etc.
20. What church/denominations have you attended mostly?