Forms Release of Liability PDF Online × 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 NameThis field is for validation purposes and should be left unchanged. 56837 Prayer Ministry Questionnaire PDF Online × PRAYER MINISTRY QUESTIONNAIRE CONFIDENTIAL Step 1 of 4 25% Name First Last Date MM slash DD slash YYYY AgeAddress Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country PhoneHow many children in childhood familyWhere are you in family line of siblings?Relationship to father in childhood: Good Bad Indifferent Has there been a significant change in any of these at present? What of the following applied to you during your childhood? night terrors bed-wetting sleep walking Incest nail-biting unhappy childhood stammering excessive fear problems learning loneliness sexual encounters molestation broken home removed from home inappropriate touch Status of parents: alcoholic separated drugs deceased divorced Parents religious background Personal historyChurch affiliation present Church affiliation past Born again yes no Date MM slash DD slash YYYY Water baptism yes no Date MM slash DD slash YYYY Marital status married separated divorced single widowed How many children?If married before, how many times?With whom are you now living? Do you have regular devotions in the bible? Do you find prayer difficult? Do you listen to a lot of music? What type of music do you enjoy most? How many hours of tv do you watch per week? Are you adopted? Have you ever attended a new age seminar, or participated in a séance? What spiritual experiences have you had that would be considered out of the ordinary? To your knowledge, have any of your parents, grandparents, or greatgrandparents ever been involved in any occultic, cultic or nonchristian religious practices? Which of the following have you struggled with in the past or are you struggling with presently? daydreaming lustful thoughts thoughts of inferiority thoughts of inadequacy worry doubts fantasy obsessive thoughts insecurity blasphemous thoughts compulsive thoughts dizziness headaches Which of the following emotions have you had difficulty controlling or are you presently having difficulty controlling? frustration fear of death anger fear of losing your mind loneliness fear of committing suicide anxiety fear of hurting loved ones worthlessness depression hatred bitterness Moral climateDuring the first 18 years of your life, how would you rate the moral atmosphere in which you were raised?ClothingSelectOverly permissivePermissiveAverageStrictOverly strictSexSelectOverly permissivePermissiveAverageStrictOverly strictDatingSelectOverly permissivePermissiveAverageStrictOverly strictMoviesSelectOverly permissivePermissiveAverageStrictOverly strictMusicSelectOverly permissivePermissiveAverageStrictOverly strictLiteratureSelectOverly permissivePermissiveAverageStrictOverly strictFree willSelectOverly permissivePermissiveAverageStrictOverly strictDrinkingSelectOverly permissivePermissiveAverageStrictOverly strictSmokingSelectOverly permissivePermissiveAverageStrictOverly strictChurch attendanceSelectOverly permissivePermissiveAverageStrictOverly strictMedical historyEver had operations? If so, for what reason and your age at that time? Hospitalization for emotional illness yes no Why? Diagnosis, date, discharge status? Form of treatment? Currently under care of doctor or psychiatrist On drug therapy? yes no Date MM slash DD slash YYYY Discharged MM slash DD slash YYYY Subject to depression? yes no Frequency and duration Diagnosed as pms ? Do you have any addictions or cravings that you find difficult to control? (sweets, drugs, alcohol, etc.) Were you ever on street drugs? yes no How long? Are you still on them? yes no Have you been an alcoholic? Currently? Yes / No questionsHave you ever visited a fortuneteller who told your fortune by the use of cards, tealeaves, palm readings, and so on? yes no Do you read or followed a horoscope? yes no Has anyone ever hypnotized you? yes no Who? Have you ever practiced yoga or done exercises related to yoga? yes no Have you ever had a life or reincarnative reading? yes no Have you consulted a ouija board, planchette, cards, tea leaves, crystal ball, and such like? yes no Have you played with the so-called 'games' of an occult nature? (ESP, Telepathy, Kabala, Dungeons and Dragons, etc.) yes no Have you ever consulted a medium? yes no Have you ever sought healing through magic or through a Spiritualist, Christian Scientist, or anyone who practices 'spirit healing' psychic healing, hypnosis, metaphysical healing, use of the pendulum or trance for diagnosis, or any other occult means? yes no Have you been to a chiropractor who treats through the use of ying and yang, the universal life forces in the spine? yes no Have you ever sought to locate missing objects or persons by consulting someone who has psychic, clairvoyant, second sight, or psychometric powers? yes no Have you ever practiced table-lifting, levitation, or automatic writing? yes no Have you ever been given or worn an amulet, talisman or charm for luck or protection? yes no Have you, or has anyone for you, practiced water witching using a twig or pendulum? yes no Do you read or possess occult or spiritualist literature, e.g., books on astrology, interpretation of dreams, metaphysics, religious cults, self-realization, fortune telling, magic ESP, clairvoyance, psychic phenomena? yes no Do you often have nightmares or frightening dreams? Have you ever been "guided" by a dream? yes no Have you experimented with or practiced ESP or telepathy? Have you ever "thought" at a person or tried to make them call or write you by your thoughts? yes no Have you ever practiced any form of magic charming or ritual? yes no Do you possess any occult or pagan religious objects, relics, or artifacts which may have been used in pagan temples and religious rites, or in the practice of sorcery, magic, divination, or spiritualism? yes no Have you ever had your handwriting analyzed, practiced mental suggestion, cast a magic spell, or sought psychic experience? yes no Have you ever belonged to the Masons, Demolay, Job's Daughters? yes no Have you been involved in a lodge or organization requiring rituals for membership? yes no Do you see auras? yes no Do you ever 'feel' an evil presence? yes no Have you ever been visited by a demon or an evil spirit? yes no Have you ever gone in any temple or building that was not Christian (Buddhist temple, Mormon temple, etc.)? yes no Have you ever been involved in any group involved in rebellion or terrorism? yes no Have you had negative things or curses spoken over you? yes no Does your name have any particular significance as to family tradition or cultural/national heritage? yes no Did your parents wish you were of the opposite sex? yes no Have you read literature by Jean Dixon? yes no Have you read literature by Edgar Cayce? yes no Have you been involved in satan worship? yes no Have you ever practiced Astral projection? yes no Have you been involved in white magic: doing good things through the control of psychic and supernatural power? yes no Have you been involved in black magic: psychic control through curses, use of the black arts, or any demon power for the purpose of harm? yes no Have you ever been involved or attended any of the Eastern religions? Buddhism Transcendental Meditation Hinduism Meher Baba Shintoism Hare Krishna Moslem Any Guru Rosicrucian The Riddle of Reincarnation Baha’I Zen Buddhism Dhagwan Shree Rajneesh Have you ever been involved in or attended meetings conducted by modern cults, such as: Mormons Christian Science Theosophy Unity Unitarian Jehovah’s Witnesses The Way FORUM(E.S.T.) Eckankar Silva Mind Control Children of God Scientology Unification Church You end up places, but do not know how you got there? yes no Does your handwriting change? yes no Do you have frequent headaches? yes no Have people accused you of often lying (especially as a child)? yes no Have you found things you do not remember purchasing? yes no Do you have or have you ever had pains in your chest? yes no Do you have difficulty trusting people? yes no Have you ever been told "I can't tell"? yes no Have you been told you were special or chosen? yes no Did you have a keen interest in sex before puberty? yes no Do you have a fear or bathrooms or bathtubs? yes no Have you had dreams with candles, hooded figures, or snakes ? yes no Was your favorite color of clothing in high school black, orange, green or red? yes no Do you have a tendency to tuck yourself in carefully at night? yes no Do you feel people are watching you all the time? yes no As a child did you believe there were monsters in the closet or under the bed? yes no My birthday is a good day? yes no Do you have difficulty taking communion? yes no Are you afraid of men, doctors, or authority figures? yes no Are you are generally afraid of the dark or of the night? yes no Are you afraid of being alone? yes no Have you ever heard voices? yes no What do they say to you? Have you had any unusual eating habits? yes no Do you regularly wake up at 12:00 or 3:00? yes no Have you ever done table lifting? yes no Do you have difficulty with using curse words or is there a curse word that regularly comes to your mind? yes no Do you have the ability to know before the phone rings that it is going to ring and who will be on the phone or that the door bell will ring and who will be at the door? yes no Can you read other peoples minds? yes no Can you project your thoughts to others? yes no Have you had an abortion? yes no Are you adopted? yes no Have you made any blood pacts? yes no Have you ever felt you have had sex with a demon (incusi or succabae)? yes no Have you suddenly had a feeling that you wanted to commit suicide? yes no Have you ever had choking sensations or pains which seem to move and for which there is no medical cause? yes no Have you viewed X-rated movies? yes no Have you ever had iris diagnosis, color therapy, or peditherapy? yes no Have you looked at pornography? yes no Do you have a tendency to be a perfectionist? yes no Do you have a tendency to want items to be in a neat state? yes no Do you print precisely at times or write and then go to printing and then write again? yes no Have you ever wanted to cut yourself or have you ever cut yourself? yes no Have you ever lost any time? yes no Have you found yourself explaining why you are somewhere because you did not know how you got there? yes no Have you or any of your family members been involved in the Masons. yes no Have you been out of the country as a soldier of the military. yes no Have you been out of the country on a mission's trip. yes no Are you or have you been a member of any fraterinity or sorierty? yes no Have you read any Harry Potter Books? yes no Have you been involved with Pokemon material? yes no Do you play video games? yes no Consent(Required) I understand this document will be seen only by the John G Lake Apostolic Healing Center Prayer Ministry Team and Lead Pastor Tina Jones.Date MM slash DD slash YYYY CommentsThis field is for validation purposes and should be left unchanged. 67806 Appointment Questionnaire PDF Online × QUESTIONNAIRE How many times a week do you read your bible?(Required) How many times a week do you pray? How long?(Required) If you fast what are usually the reasons for it?(Required) How often do you fast? What do you fast?(Required) Do you live a fasting life style?(Required) Do you have a Prayer Partner?(Required) How often do you go to church or bible study/prayer group a week?(Required) How many people a week do you share your testimony or share your faith with?(Required) How often do you spend in worship a week (music only)?(Required) What do you think is stopping you from receiving God's promises or blessings in your life ?(Required) What do you think are the most common sin's you commit?(Required) How much time do you talk to God a week?(Required) What promises do you feel God has made that you do not have?(Required) How did you come to being a Christian (if not please put N/A)(Required) Do you see Jesus?(Required) Name(Required) First Last CommentsThis field is for validation purposes and should be left unchanged. 22619 Testimonial Online × "*" indicates required fields Name* First Last Phone*Email* Testimony*Please select one* I give permission for my testimony to be shared under my first name and last initial (ex. John L.) I do not give permission for my testimony to be shared online or on social media. EmailThis field is for validation purposes and should be left unchanged. 16206 Volunteer Application PDF ONLINE EH Student Application PDF Online × Elijah House School Of Prayer Ministry Mark all that apply Mr. Mrs. Ms. Miss. Pastor Widow Single Parent Non U.S. Citizen Name First Last Spouse First Last Address Street Address City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÃ…land Islands Country Church Home PhoneWork PhoneFaxEmail Occupation AgeWhich of the following Elijah House books have you read? Restoring the Christian Family Transforming of the Inner Man God’s Power to Change Letting Go of Your Past Growing Pains Deliverance and Inner Healing Elijah Task Healing the Wounded Spirit Transformation of the Inner Man Life Transformed The Renewal of the Mind Healing Victims of Sexual Abuse Why Some Christians Commit Adultery Why Good People Mess Up Which of the following Elijah House Classes have you completed? Course 201 (Basic 1) school Prophetic School Course 202 (Basic 2) school Healing of Trauma Seminar Other Elijah House Seminars/Classes Which Other? How long have you been a Christian? Date of Salvation MM slash DD slash YYYY Please give a brief account of when and how you became a Christian.How are you presently serving the Lord?Are you in a relationship with a spiritual leader in a pastoral role who knows you, is aware of your spiritual condition, and can hold you accountable? Yes No Are you presently ministering to others? Yes Lay/Church Lay/Private Professionally No If not, do you plan to do prayer ministry after completing this training? Yes No Don’t Know Special Needs or requests (please circle what applies, and briefly explain): Allergies Medication Disability Dietary Other None Briefly explain:Because we are dealing with the hearts of people, the school can – at times – be very intense. Personal responses to teaching and small group interaction may include (but is certainly not limited to) some of the following: expression of anger, prejudices and resentments, apprehension, anxiety, insomnia, depression, dissociation, etc. Note: If a crime is confessed in small group during the course of the school, the Facilitator/leader of your small group will need to report it to the Director/Facilitator of the school. The Director/Facilitator of the school, in accordance with the laws of thatstate, may need to report it to the proper authorities. Because of time restraints, all of your personal life issues will not be dealt with during the course of the school. This is a life-long process. However, we do give you the tools to pursue further healing, and you may want to pursue further ministry once the school is complete. If you feel there are already significant life issues that need to be addressed, ministry or counseling prior to your enrollment in the school is advisable and always beneficial. If you have been seeing a counselor, we ask that you discuss the school with your counselor and receive their approval. Their signature is required below. Having accepted the school enrollment information, requirements outlined in this application, and the ElijahHouse Facilitated School Booklet, I prayerfully submit my application. I agree to respectfully abide by the determination of Elijah House as to the suitability of my attendance at this time. I agree to indemnify and hold Elijah House and any Host Facility harmless for any of my personal responses to the teachings and small group time during the school. I also agree to indemnify and hold Elijah House and any Host Facility harmless for any costs in time, travel, accommodations, or other incidentals, should the school be canceled, my acceptance be delayed, or I am asked to discontinue the course to seek ministry before continuing at another time. I agree to maintain the confidentiality of what is shared by leaders and students in class and small groups. I understand that I may be filmed or photographed during the event for use in future training events and advertisement for display without using my name, and I give permission for use of my image/picture in this way. Consent(Required) I understand that my signature testifies that all information provided is true, that I accept all terms of enrollment,and will provide sufficient funds in a timely manner for my participation in the school.Applicant’s Signature:(Required) Date(Required) MM slash DD slash YYYY Spouse’s Signature: (Spouse’s Signature is required regardless of whether or not he/she is attending)Date MM slash DD slash YYYY Counselor Name (if applicable): Counselor Signature: Address Street Address City State / Province / Region ZIP / Postal Code PhonePhoneThis field is for validation purposes and should be left unchanged. 86380
