Restoration Enrollment

Great job taking the first step toward getting help! We just need you to complete the Restoration Enrollment form below, and a member of our Restoration team will reach out shortly to get you started in the program.

Restoration Enrollment Form

As you answer questions your progress will be saved.

Music of Life Church Kimberly's Restoration Program is not mental health crisis program.

If you need help with a mental health crisis or emergency situation, please contact the appropriate service.

If you need help finding a service, please check the following:

Call 911 if there is an immediate danger to yourself or others.

Call or Text 988 to reach the 988 Crisis & Support Lifeline, available 24/7 for free and confidential support related to mental health, emotional distress, or substance use.

Visit https://988lifeline.org for live chat and additional mental health resources.

1. General Information
2. Church Information
If you're a member of a church, we'd ask that you let your pastor know your intentions of coming to Music of Life Church Kimberly for help in this area. You do not need to be a member of Music of Life Church Kimberly to go through The Restoration Process but we want to respect the spiritual covering you currently have through your pastor.
3. Counseling Information
If you're seeing a counselor, we'd also appreciate you getting their permission. We want you to be given clear direction for dealing with your mental and emotional life and we don't want to get in the way of any process that is working for you.
4. Marriage Information
If you're married, we'd appreciate you making your spouse aware. We're not asking you to get 'permission' to do The Restoration Process. We are just trying to facilitate open communication with your spouse.
5. Tell us about why you want Restoration
6. What is your schedule?
In person coaching is only available in and around the Fox Cities of Wisconsin.
7. Definitions
The definitions of key words is paramount to the Restoration Process. With that said, can you please state what your definitions are for the following words? If you're unsure about how to define any of them, we encourage you to give it a try. It is better to state an answer rather than no answer at all.
8. Questions