The form below will allow you to enter your information, select your program options and select a username and password for the portal. Once you have made your selections, you will have the option of viewing and editing them later.

There are a few options that you will not be able to edit later. You may want to gather this information before you begin the registration process. The options you will not be able to edit are:

Skip to the registration form.

The Spirituality of Well-being Index Score – If you are going to enroll in any Spiritual Care options, please complete the instrument and write down your score to enter into the signup form.

SPIRITUALITY INDEX OF WELL BEING INSTRUMENT

You will also be asked to rate your current level of spiritual care on a scale from 1 to 10.

The Life Changes for Clergy Score – If you are going to enroll in any Emotional/Mind Care options, please complete the instrument and write down your score to enter into the signup form.

Life Changes for Clergy

You will also be asked to rate your current level of mind/emotional care on a scale from 1 to 10.

BMI/Weight/Height BMI Calculator.– If you are going to enroll in any Body Care options, you will be asked to enter your BMI, weight, and height. You are welcome to use our

Registration Form

Note: Business or Client Name should be your name. Contact Name should be your preferred first name.

Business or Client Name is required
Contact Name is required
Invalid Email, proper format "name@something.com" Email is required
Please include if enrolling in Buddy Spouse System
Street Address is required
City is required
State is required
Zip is required
Appointment (Church or Organization) is required
Select District
District is required




You have the option of choosing any one of the components or all of them. Check All that apply.
ENROLLMENT: Select the self-care component area in which you want to enroll. is required
SPIRITUAL WELLNESS CARE See Spiritual of Well-being Index Form to obtain score. Form is provided on Clergy Wellness Program APP or visit www.riotexaswellness for spiritual care items for participating options and Quick Reference Listing.
Rate your present level of Spiritual Care (1 being the lowest and 10 the highest). Check the one that applies.
MIND/EMOTIONAL WELLNESS CARE See Lifes Changes for Clergy Form to obtain score. Form is provided on Clergy Wellness Program APP or go visit www.riotexas.org Clergy Wellness Program webpage and download form. Also, for all available options offered to participation or see Quick Reference Listing.
(1 being the lowest and 10 the highest). Select the one that applies.



You have the option of choosing any one of the components or all of them. Check All that apply.


You have the option to choose your physical care program that best works for you according to your needs from weight loss to increasing physical activity and even participate in challenges with goals you set for yourself.




In order to receive incentives for the monthly challenges reporting and activity logging are required or can be uploaded on reporting appropriate form.
BMI Calculator available at riotexaswellness.org




THREE-IN-ONE (Spiritual, Mind/Emotional and Physical) The three in one is for clergy that have been approved for Sabbatical Leave. All three components of Spirit, Mind and Body will need to be completed where applicable during their Sabbatical Leave and a final report submitted on their overall wellness care plan
Signature of Accountability (Required) is required

Username is required
Password is required
Confirm Password is required
>> HINT: The password should be at least seven characters long. To make it stronger, use upper and lower case letters, numbers and symbols like ! " ? $ % ^ & ).
 
  Check to Enable