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About
WHO WE ARE
IN ASSOCIATION WITH
WE BELIEVE
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Meet Denise
PACEM COACHING
EVENTS
ElevateHER®
About
Current Students
Ephesians 2021
HOUSES OF PEACE
STORE
Donate
Arise! Women
Home
About
WHO WE ARE
IN ASSOCIATION WITH
WE BELIEVE
Contact
Meet Denise
PACEM COACHING
EVENTS
ElevateHER®
About
Current Students
Ephesians 2021
HOUSES OF PEACE
STORE
Donate
Contact Information
*
First Name
Last Name
Cell Phone
*
(###)
###
####
Email
*
1. Marital Status
*
Single
Married
Divorced
Separated
Widow
2. Church Home (includes traditional or house/micro-churches)
*
3. Describe your relationship with God. (How long you have been a Christian, faith journey, etc.)
*
4. What is your reason for signing up for a prayer appointment?
*
5. What is your desired outcome for this prayer appointment? (Example: "I want to stop my excessive worrying." "I want to let go of hurt." "I want to feel free," etc.)
*
6. List the type of prayer ministry you would like to receive.
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General Prayer
Deliverance Ministry
Prayers to Encourage You
7. Have you received healing prayer or deliverance ministry before? Please describe.
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8. Are you currently, or have you previously been, under the care of a professional counselor or psychiatrist? If yes, please describe.
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9. Please select all that currently apply to you:
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Depression
Anxiety
Insomnia
Low Self-Esteem
Suicide or Suicidal Thoughts
Eating Disorder
Unforgiveness/Bitterness
Drug/Alcohol Abuse
Grief/Loss
Physical Abuse
Sexual Abuse
Emotional Abuse
Recent Severe Personal Trauma
Trauma in Family or Close Friend (untimely death, suicide, end-of-life diagnosis)
None of the Above
10. Give a brief description for each experience you checked in Question 9. If none were checked, write "none."
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Waiver of Liability. Please read before signing.
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I, the undersigned, do hereby release Arise! Women and their volunteers and/or staff from any liability for any harm, or perceived harm, resulting from my voluntary receipt of free prayer ministry at this conference. I understand that Arise! Women is staffed by volunteers representing the greater Body of Christ and reflecting many denominations and churches. They are not trained or licensed professionals of counseling, therapy, or medical services, and are not licensed or insured as such. I understand that Arise! Women is a prayer and spiritual ministry center and not a licensed counseling, medical, or therapeutic center. Therefore, Arise! Women does not routinely keep detailed records and will not provide information for lawyers, or disability claims, or similar matters. I understand that if I am currently taking medication or operating under the advice of a professional service, I will allow them (my medical doctor, therapist, counselor, etc.) to confirm any results of prayer received before altering any prescribed course of action. I also release Arise! Women and their volunteers and/or staff from any liabilities of first-time knowledge of physical and/or sexual abuse to a minor that is told to them during prayer time. I understand that under the laws of Minnesota, they are obligated to contact the proper authorities regarding this knowledge. I understand that if my prayer appointment is held in a church building, the church has no authority or responsibility over Arise! Women and their volunteers. I understand that my personal files are protected as “CONFIDENTIAL.” As such, identifying specific details of my file may not be disclosed to others without my written consent except as specified by Minnesota law: 1) as required by subpoena or court order in legal proceedings, 2) when not to do so would potentially result in physical harm to myself or others, 3) to report any disclosure/suspicion of child/elderly neglect or abuse (physical or sexual). I understand that the volunteers are required to consult periodically with the leaders of Arise! Women. I give my permission for my prayer ministers to discuss my prayer needs with the appropriate staff as necessary. If at any time I feel offended by anything my prayer minister asks, says, or does, I acknowledge that it is my responsibility to report it immediately to the staff of Arise! Women. For Online Appointments: I understand that I will be using a third-party video conferencing program to communicate during my online prayer appointment. Houses of Peace/Arise! Women will not record these ministry appointments and will work to keep my time of ministry as secure as possible. With any online platform, there are certain security risks. In the rare case of security breach, I will not hold Houses of Peace/Arise! Women liable for any security issues pertaining to my online prayer appointment.
First Name
Last Name
Date
*
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DD
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Although we do not charge for the prayer appointments, we suggest a donation of $40/session. However, you are welcome to receive prayer regardless of whether you donate or not. If you choose to support this prayer ministry of Arise! Women, please click on the “DONATE” button at the top of the webpage.
Thank you! We are praying for you!