Freedom Mentoring Interest Form

In the case of an emergency, please dial 911.

Thank you for your interest in TGP's Freedom Mentoring Ministry.

This form is simply letting us know you are interested in participating in Freedom Mentoring. It is not a guarantee that we will be able to provide you with services. Once you fill out the form below, a member of our team will get in touch with you via email within 3-5 business days.

Your name *

Email address *

Birthdate *

Gender *

Marital status

Phone number *

Do you attend The Gathering Place Church? *

Yes

If YES, what are you involved in? / If NO, what church do you attend? *

What has led you to seek mentoring?: *

What type of mentoring are you seeking? *

If you are parent seeking mentoring for a child (anyone under the age of 18 years old), our policy requires we mentor parents first, a minimum of 8 sessions.

Have you met with a mentor/counselor/therapist before? *

If so, please include their name and practice, any diagnosis', or any other relevant information.

Did anyone refer you?: *

If so, please include their name.

If accepted for mentoring services, what are some days and times you are regularly available? *

We are only available for Freedom Mentoring appointments during the days and times below:

Mondays through Thursdays from 8:00am - 4:00pm
Sundays from 7:00am - 10:00am

Is there other information you would like to share with us?: *