Release of Liability PDF form ONLINE FORM CHARACTER REFERENCE for Student Application 1. How long have you known the applicant? (months) 2. How would you evaluate the applicant in the following areas? (5 = strongest and 1 = weakest) Humility 5 4 3 2 1 Don´t know Mournful over sin 5 4 3 2 1 Don´t know Gentle; meek 5 4 3 2 1 Don´t know Seeks to do things God’s way 5 4 3 2 1 Don´t know Merciful 5 4 3 2 1 Don´t know Pure in heart 5 4 3 2 1 Don´t know Peacemaker 5 4 3 2 1 Don´t know Self-controlled 5 4 3 2 1 Don´t know Heart for the lost 5 4 3 2 1 Don´t know Cares for others 5 4 3 2 1 Don´t know Integrity 5 4 3 2 1 Don´t know Overall Spiritual Maturity 5 4 3 2 1 Don´t know 3. What areas in the applicant’s life do you feel need development?4. What areas in the applicant’s life do you see as strengths?Signature: Date MM slash DD slash YYYY Name First Last Relationship to Applicant PhoneAddress City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State NameThis field is for validation purposes and should be left unchanged. 42375 After care sheet PDF form ONLINE FORM Healing Rooms "*" indicates required fields If minor (age)Name* First Last PhoneEmail* Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Spouse's Name Church Affiliation Born Again* Yes No Married* Yes No Baptized in the Holy Spirit* Yes No Children* Yes No If Minor, Name of Mother/Father First Last Are you currently under Doctor or other Professional Care* Yes No Prayer NeedHow did you hear about the Healing Rooms? I, the undersigned do hereby release Healing Rooms 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 staffed by volunteers representing the broad body of Christ and reflect many denominations and churches. They are not trained or licensed professionals of counseling, therapy or medical services. I understand that If l 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 understand that this form and all data recorded on it Is the sole property of Healing Rooms. All content will be held In confidence for the sole purpose of ministry to the above.Signed* Date MM slash DD slash YYYY Parent/Sign Date MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged. 12417
Release of Liability PDF form ONLINE FORM CHARACTER REFERENCE for Student Application 1. How long have you known the applicant? (months) 2. How would you evaluate the applicant in the following areas? (5 = strongest and 1 = weakest) Humility 5 4 3 2 1 Don´t know Mournful over sin 5 4 3 2 1 Don´t know Gentle; meek 5 4 3 2 1 Don´t know Seeks to do things God’s way 5 4 3 2 1 Don´t know Merciful 5 4 3 2 1 Don´t know Pure in heart 5 4 3 2 1 Don´t know Peacemaker 5 4 3 2 1 Don´t know Self-controlled 5 4 3 2 1 Don´t know Heart for the lost 5 4 3 2 1 Don´t know Cares for others 5 4 3 2 1 Don´t know Integrity 5 4 3 2 1 Don´t know Overall Spiritual Maturity 5 4 3 2 1 Don´t know 3. What areas in the applicant’s life do you feel need development?4. What areas in the applicant’s life do you see as strengths?Signature: Date MM slash DD slash YYYY Name First Last Relationship to Applicant PhoneAddress City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State NameThis field is for validation purposes and should be left unchanged. 42375
After care sheet PDF form ONLINE FORM Healing Rooms "*" indicates required fields If minor (age)Name* First Last PhoneEmail* Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Spouse's Name Church Affiliation Born Again* Yes No Married* Yes No Baptized in the Holy Spirit* Yes No Children* Yes No If Minor, Name of Mother/Father First Last Are you currently under Doctor or other Professional Care* Yes No Prayer NeedHow did you hear about the Healing Rooms? I, the undersigned do hereby release Healing Rooms 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 staffed by volunteers representing the broad body of Christ and reflect many denominations and churches. They are not trained or licensed professionals of counseling, therapy or medical services. I understand that If l 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 understand that this form and all data recorded on it Is the sole property of Healing Rooms. All content will be held In confidence for the sole purpose of ministry to the above.Signed* Date MM slash DD slash YYYY Parent/Sign Date MM slash DD slash YYYY EmailThis field is for validation purposes and should be left unchanged. 12417
