Inner Healing Session Application

Name

First NameLast Name

Email

example@example.com

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Preferred Method of Communication:

TextCallEmailAll of the above

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How did you hear about Inner Healing Ministry?

Do you regularly attend church?

YesNo

If so, what church?

How long have you been attending your church?

Have you received Inner Healing ministry in the past?

YesNo

If so, when and with who?

Please take a moment and share why you'd like to receive Inner Healing Ministry.

Did someone refer you to Inner Healing? If so, who?

Do you attend a small group? (If not, we strongly recommend that you find one and share with a spiritual leader you trust about your session to help with accountability.)

YesNo

Please check any of the following that currently applies to you.

Will you be able to fast or pray one week before your Inner Healing Session? (Ask the Lord what He wants you to fast. It can be one meal a day, watching TV, or the internet, etc.)

YesNo

Our Inner Healing team lovingly gives their time to serve and pray with others. While there is no cost for a session, a suggested donation of $30 helps us continue offering this ministry and supporting the resources that make it possible.

Liability Release for Champions Church Inner Healing Ministries

I acknowledge that team members from Champions Church Inner Healing Ministries have voluntarily agreed to pray for me. I understand that this session is not a professional counseling meeting. I understand that these team members are, to the best of their ability, doing what they can to help me achieve more freedom in my life.

I understand Champions Church is a non-profit Florida corporation that makes no charge for its services. I further state that I have voluntarily sought assistance of my own initiative and that I under no obligation to accept for reject any of the advice or help htat I might receive from the team members of this ministry.

Our team members offer biblical spiritual services to anyone who desires them. Although there is no charge for our services, you are welcome to make a donation if you so desire. Any contributions to this ministry will continue to help support our further development and make a difference in the lives of others. If you choose to make a donation, please make checks payable to Campions Church - Inner Healing Ministry. Your donation is tax deductible and if you'd like a tax deductible receipt, we will provide one for you.

I understand that if I receive ministry from Champions Church's Inner Healing Ministries, the team is committed to respect the disclosed information, but not to complete confidentiality. If necessary, the information may be shared with otherleaders of Champions Church's Inner Healing Ministries to further your total healing process. This may include future meetings with spiritual mentors in the church to set appropriate boundaries for your personal and spiritual growth. I understand that Champions Church madatorily reports child and elder abuse to the proper authorithies.

I agree to hold Champions Church and its team members free from any and all liability, loss or damage of any kind that may arise as a result of assistance, which I have received, or from involvement with Champions Church.

I have read this disclaimer and release of liability and understand and agree with it and have executed it as my free and voluntary act.

Signature*

Date*

Date