Freedom Ministries Application Form

Name

First

Last

Date of Birth

Email

Mobile

Type of ministry that you are applying for:

Prayer Ministry

Deliverance

Both prayer ministry and deliverance

In what way would you like your prayer ministry to take place?

In person

Online

1. What are the current issues you want to address at Freedom Ministries?

Please be specific and please limit your answer to a paragraph.

2. Have you ever been diagnosed, or has it been suggested that you be tested for any of the following:

BPD or EUPD (Emotionally Unstable Personality Disorder)

DID (Dissociative Identity Disorder)

DID with SRA (Satanic Ritual Abuse)

ASD (Autism Spectrum Disorder

Bi-Polar

Schizophrenia

Clinical Depression (We are looking here to see if the depression is debilitating and if you are unable to concentrate, focus, or deal with deep issues of the heart).

Any other mood disorder, diagnosis.

None of the above

It is essential for us to know if you have been diagnosed with any specific medical conditions. This is asked of everyone and done for two reasons: • So, we can determine whether we are able to provide the help you are seeking. • To assure your safety during your ministry time with us.

3.1 If you have been medically diagnosed with any of the above - When was that diagnosis made?

3.2 Are you receiving treatment?

No

Yes

3.3 If yes, what kind of treatment?

3.4 Are you seeing a therapist?

No

Yes

3.5 Are you on a prescribed medication for this issue?

No

Yes

4.1 Have you had any type of ritual abuse (such as cult or satanic ritual abuse?

No

Yes

4.2 If yes, briefly explain.

5.1 Do you have any addictions such as alcohol or drugs?

No

Yes

5.2 Are you currently using marijuana?

No

Yes

5.3 Are there any other addictions? Please specify.

Anyone currently addicted to alcohol or other drugs will need to have stayed clean and sober for 90 days before having prayer ministry with Freedom Ministries.

6.1 Have you ever planned or attempted suicide?

No

Yes

6.2 If yes, when?

6.3 Relate the necessary details of this event here -

RELEASE & DISCLAIMER FORM - I acknowledge:

I understand the above information concerning prayer ministry.

I have sought prayer ministry of my own free will.

All personal information I reveal is given voluntarily in order to facilitate the healing process.

I release my Prayer Ministers from any liabilities and retributions.

I further understand that, if at any time the Prayer Minister determines that I require services beyond his or her scope of training they will decline to provide services. If this occurs, the Prayer Minister may be able to provide a reference to other professionals or agencies. I acknowledge that a referral represents only a suggestion as to where I might obtain assistance, and in no way obligates the Prayer Minister or the referred professional or agency.

I recognise that the outcome of prayer ministry is dependent upon a number of factors and results cannot be guaranteed.

I have read all of the preceding information and understand the purposes of prayer ministry and am aware of its limited scope of services as well as compliance to Freedom Ministries’ duty of care policies.

1. I am the person named above and have completed this form myself.

Yes

No

2. I have read and agree with the above terms of prayer ministry with Freedom Ministries.

Yes

No

Signed

Full Name

Date:

Freedom Ministries Application Form

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More Information about Elijah House

Paradox Church

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Prayer Gatherings

Paradox Church