| Name: |
|
Cell Phone Number:
(So we can text you when a team is ready) |
(International phone number?
Start with "+".) |
Email Address:
(So we can email you if necessary) |
|
Preferred Contact Method:
(So we know how to contact you when a team is
ready) |
Text Message (reliable, fast)
Email Message (reliable, slower)
Phone call (less reliable, slower) |
| Type(s) of Ministry Desired: |
Healing
Prophetic |
| Postal Address: |
|
| City: |
|
| State/Province: |
|
| Zip/Postcode: |
|
| Country: |
|
| Spouse’s Name: |
|
| Church Affiliation: |
|
| Children? |
Yes
No |
Born Again?
(Have you asked Jesus into your heart?) |
Yes
No |
Baptized in the Spirit?
(Do you have a prayer language?) |
Yes
No |
| Are you over the age of 18? |
Yes
No |
| If not, name of parent/guardian: |
|
Under a doctor’s care?
(or other health professional) |
Yes
No |
Prayer Need:
|
How did you hear about the
Healing Rooms of Loveland? |
|
|
Legal Liability Release
I, the undersigned, do hereby release
Healing Rooms Ministries, the Healing Rooms of Loveland, and their
volunteers or staff from any liability for any harm or perceived harm
resulting from my voluntary receiving of free prayer on this and
subsequent visits. I understand that these Healing Rooms are a staff
of volunteers representing the broad body of Jesus Christ and reflect
many denominations and churches. They are not trained or licensed
professionals of counseling, therapy, or medical service. I will
allow my medical professionals (medical doctor, therapist, counselor,
etc.) to confirm any results of prayer received before altering any
prescribed course of action. I understand this form and all data
recorded on it is the sole property of the Healing Rooms of Loveland.
All content will be held in confidence for the sole purpose of the
ministry to the above.
|
| By checking this box, I certify that I understand and agree to abide
by the above Legal Liability Release. |
I
Agree |
|
