The Thriving Relationships Workshops For Marriages & Long-Term Relationships Registration Form

Your answers will be confidential and any data analyzed will be anonymized.

Please answer all questions honestly

Session (Choice) *

Winter Jan 18th - March 8th 2025

What is your gender? *

Male

Female

Non Binary

Other

Your Age Range *

What is your phone number? (This is required for us to contact you with Thriving Relationship Workshop relevant information) *

What is your ethnic or cultural origin? *

Native/ Indigenous

Black (African, Afro-Caribbean, African-Canadian Descent)

East Asian (Chinese, Korean, Japanese, Taiwanese descent)

Latino (Latin American, Hispanic descent)

Middle Eastern (Arab, Persian, West Asian descent, e.g. Afghan, Egyptian, Iranian, etc)

South Asian (South Asian descent, e.g. East Indian, Pakistani, Sri Lankan, Indo-Caribbean, etc.)

Southeast Asian (Filipino, Vietnamese, Cambodian, Thai, other Southeast Asian descent)

White (European descent)

Are you a person of faith? *

Yes

If Yes, Please indicate what faith you belong to?

How long have you been in Canada? *

Please state the relationship status between you and your partner *

Married

Unmarried but have been together for 5 years or more

Engaged

Dating Long term relationship

If married, please provide wedding date. (This data will be used by TMA Canada to celebrate you on your wedding anniversary)

How many years have you been married? (If not married, how long have you been in a long-term relationship? *

Partner's First Name *

Partner's Last Name *

Your Partner's Email *

Partner's phone number? (This is required for us to contact you with Thriving Relationship Workshop relevant information) *

Your Partner's Age Range *

What is your partner's gender (choice)? *

Male

Female

Non Binary

Other

What is your Partner's ethnic or cultural origin? *

Native/ Indigenous

Black (African, Afro-Caribbean, African-Canadian Descent)

East Asian (Chinese, Korean, Japanese, Taiwanese descent)

Latino (Latin American, Hispanic descent)

Middle Eastern (Arab, Persian, West Asian descent, e.g. Afghan, Egyptian, Iranian, etc)

South Asian (South Asian descent, e.g. East Indian, Pakistani, Sri Lankan, Indo-Caribbean, etc.)

White (European descent)

Are you both able to commit 3 hours on 8 consecutive Saturdays to the Thriving Relationships Workshops? (Childcare will be provided at the same site) (choice) *

Yes

How many Children do you have? *

Will Childcare be needed? *

Yes

If you will use our childcare services during this program, please provide the name(s) of Child(ren) and their age(s) (First Child Name Age, Second Child Name Age) Eg: Sarah 12, John 8

Please leave us a detailed note about your child(ren) if there are special provisions that we should make. (E.g special needs, neurodivergent, special diet etc)

What was your total household income before taxes in the last tax year? *

Identify key areas of growth that you would like to focus on while enrolled in this program. This will be useful to pair you with a relationship mentor couple. *

You have access to a mentor couple that can support your relationship during the 8-week Thriving Relationship Program and thereafter if needed. Would you like to be assigned a mentor couple? If YES, proceed to the last question *

Yes

Other

Using the link below, please read our mentors bios and select your 1st choice? You will be allocated to mentors based on their availability. *

Using the link below, please read our mentors bios and select your 2nd choice? You will be allocated to mentors based on their availability. *

Using the link below, please read our mentors bios and select your 3rd choice? You will be allocated to mentors based on their availability. *

If you experience distress in your relationship and need someone to talk to, who are you most likely to contact? *

How did you hear about the program? *

Are you happy for us to contact you in the future about other programs that we run? *

Yes