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Personal Prayer Appointment Registration

Personal Information

First Name *

Last Name *

Email *

Phone *

Street *

City *

State *

Zip *

Emergency Contact Name *

Emergency Contact Phone Number *

Gender *

Age *

I found ONE by:

Referral
Online
Driving By
Brochure
Other

If referred, who referred you?

What, if anything, has prompted you to schedule a personal prayer appointment?

Do you have a preference for the make-up of your prayer team?

Do we have your permission to share your story with anonymity for the purpose of testimony or as a learning tool for those in training with this ministry? *

LIABILITY RELEASE FOR ONE

I fully understand that team members from ONE have voluntarily agreed to pray for me. I realize that this session is not professional counseling and that no one on this prayer team is a licensed counselor.

I acknowledge that this service is provided free of charge. I acknowledge I have sought assistance of my own will and realize that I am under no obligation to accept or reject any information received during this prayer time.

I understand that in agreeing to receive ministry from the ONE Prayer Team, the team is bound by honor to respect personal information shared, so long as it does not prove to be a danger to myself or others to do so.

I promise to hold ONE and its team members free from any and all liability, loss or damage of any kind that arises as a result of services I have received at ONE or by a ONE Prayer Team member.

I have read and fully understand this Liability Release and acknowledge that I am purposefully waiving personal rights I may otherwise have against ONE and its volunteers. Being of sound body and mind, I voluntarily execute this Liability Release as indicated by my form submission and electronic signature below.

I have read the above paragraphs and agree in full: *

Electronic Signature: *

If under 18, Parental Electronic Signature - As guardian, I agree to all parts of the attached consent form for my child to receive prayer from ONE Prayer Team:

We encourage you to reach out to one or two people you feel comfortable with and ask them to pray for your time at the center. It can also be helpful to meet with them after your prayer time to share what you experienced and what God did in your time at ONE.

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