HomeBuilders Facilitator
Application & Agreement
Husband’s Name _________________________________ Wife’s Name _________________________________
Address ______________________________________________________________ Date __________________
Home Phone __________________ Husband’s Cell ____________________ Wife’s Cell ____________________
Do you believe in Jesus Christ as you Lord and Savior?
Yes/No
Husband
Wife
Please read and check the following circles:
o
o
o
o
I have read the Celebration Church “What We Believe” Core Values, and I am in agreement with them.
I am a member of Celebration Church, or I am in the process of completing the Discovery Class.
I have been a growing Christian for at least 5 years and have been married to the same person for at least
the last 7 years.
Should the following come to my awareness during interaction with those who join a HomeBuilders group
I understand that I am required to contact one of our Marriage Ministry Consultants to determine an
appropriate course of action, if any.
Abuse:
Child abuse: Includes physical abuse, neglect, sexual abuse and psychological harm. Physical abuse is non-accidental physical trauma or injury
inflicted by a parent or caretaker on a child. Neglect is defined as failure to provide for a child's physical survival needs to the extent that there
is harm or risk of harm to the child's health or safety. Sexual abuse includes indecent exposure, inappropriate touching, penetration, and the
manufacturing of pornography. Psychological harm is a repeated pattern of caregiver behavior or extreme incident(s) that convey to children
that they are worthless. (Taken from Tennessee mandatory reporting regulations)
Spousal abuse: We define domestic violence as a pattern of abusive behavior in any relationship that is used by one partner to gain or maintain
power and control over another intimate partner. Domestic violence can be physical, sexual, emotional, economical, or psychological actions
or threats of actions that influence another person. This includes any behaviors that intimidate, manipulate, humiliate, isolate, frighten,
terrorize, coerce, threaten, blame, hurt, injure, or wound someone. (Taken from the US Department of Justice)
Harm:
To Self - This would involve threats or attempts to injure, maim, or to kill oneself (suicide). This could include cutting, disfiguring, or
planning/attempting suicide. All threats of physical harm should be taken seriously.
To Others - This would include threats or attempts to injure or kill (homicide) another person. It is an extreme act of violence that is often
driven by a strong desire for revenge. This person may feel as though they have been wronged or believe this is the only way to protect
themselves or a loved one.
Are any of the Red Flag Statements below true for you? If so, this may not be the best time for you to invest in the
lives of others.
Red Flags
a) You are currently battling any kind of addiction (gambling, pornography, drugs, alcohol, etc.)
b) You have uncontrollable emotional outbursts that you have not yet managed.
c)
You have recently suffered a significant setback (financial, emotional, etc.).
d) Your marriage is not stable or is fraught with frequent conflict.
e)
You have suffered serious emotional wounds from abuse in your life and you are still trying to find healing.
f)
You are struggling with significant financial debt.
g)
One of you is far more motivated to become a marriage mentor than the other.
h) You do not have a sense of meaning and purpose in your life.
i)
You are pessimistic about marriage in general.
j)
You avoid personal responsibility for problems in your life.
k)
You are not content and at peace with your life and your marriage.
l)
You are not living your life by submitting to Biblical principles.
m) You are primarily motivated to facilitate a group to help your own marriage.
n) You have been told by others that you may not be in a good place to be a facilitator right now.
According to the Red Flag Statements above, we are in a good place to be effective facilitators.
Yes/No
Husband
Wife
If you are considering facilitating a particular study, please state the name of the study along with possible location
and date:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
For your convenience you may want to forward a copy of this form to Dan Jordan at jordandw@chartertn.net.
and leave a signed copy in room 308 at your convenience.
Husband’s Signature ____________________________ Wife’s Signature ______________________________
Date ____________________________
Date ____________________________