Interest Form

We are so thankful for your interest in Walk Right In Ministries! We would like to get to know you and learn what is important to you.

Please take 10 to 15 minutes to complete this informal survey and tell us about yourself and your family. We appreciate your patience as we develop an understanding of your situation and explore ways WRIM may be able to help.

Name *

First

Last

Email *

Telephone Number *

Married Status: *

Single
Married
Divorced

Do you attend church? *

Yes
No, but wish I could
No, not interested

In what state or province are you located?

What is your relationship to someone with disabilities or special needs? Please check all that apply. *

I am the parent of someone with special needs.
I am the sibling of someone with special needs.
I am the grandparent of someone with special needs.
I have a spouse with a disability, chronic illness, mental health condition or aging-related condition.
I have a parent with a disability, chronic illness, mental health condition or aging-related condition.
I have a disability, chronic illness or mental health condition.
I am the friend of someone affected by disability, chronic illness or mental health condition.
I work/volunteer in the area of special needs or mental health ministry
Other

If you are a special-needs parent, please tell us the age and gender of each of your children. (This is optional but helpful information for us. )

Please briefly describe the medical, developmental or mental health diagnosis that affects your family member(s)? (Only the most basic information is needed here. Details can be shared, if you choose, at a future time.)

Have you work with Walk Right In Ministries in the past?

If you indicated "other" or have need for information or resources, please explain your specific need.

Which of Walk Right In Ministries' products or services currently interests you? (Check all that apply.) *

TRAINING & DISCIPLESHIP | Caregiver Consulting | Individual & Family Counseling | Temperament Therapy
PEER CONNECTIONS | Small Group Discussion | Finding Glory Group Curriculum
INSPIRATIONAL RESOURCES | WRIM Blog | Jesus, Let's Talk | Finding Glory Books | Social Media
REFERRALS | Connections in a national network of faith-based organizations and disability-friendly churches
SPEAKING | Keynote, Workshop, Conference/Retreat Presentation, Guest Preaching
PRAYER

May the Walk Right In Ministries Prayer Team pray for you? (Please know that we are committed to keeping your name and personal information absolutely confidential. Prayer requests are shared with our Prayer Team by first name only.) *

Describe any specific prayer request(s) you would like to share.

What is the best way(s) for us to contact you? *

Email
Telephone

What time of day is best for you to connect with us?

Morning
Afternoon
Evening

How did you find out about Walk Right In Ministries? *

Website

Thank you again for contacting Walk Right In Ministries and taking time to tell us about yourself and your situation. You, your family and your situation are important to us. Someone from our Ministry Team will be contacting you within about three (3) business days to determine next steps.

We appreciate your patience and look forward to getting to know you!

NOTE: Our Prayer Team will be praying for you but will not know your name unless you gave us permission to share it (above). Please be assured that any information you share is held in strict confidence by our team at Walk Right In Ministries.

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