Gold Avenue Church Prayer Ministry Request Form

Thank you for your interest in a prayer appointment at Gold Avenue Church. Please take a few minutes to fill out this form and click submit. The information you provide will help in planning and discerning an appropriate prayer team.

Confidentiality notice

Form responses and prayer ministry appointments are confidential. Details are kept between the prayer ministry director and the the prayer team that meets with you. We do not discuss details, even among ourselves, outside of the ministry context. Details may also be shared with GAC pastors for care and support purposes.

Contact Information

Name

Address

This address will receive a confirmation email

Phone number

Name of your church (if applicable)

Prayer Information

How did you hear about our ministry?

Referral Gold Avenue Sunday Prayer Partners Gold Avenue Church Website Other

Please tell us why you would like a prayer appointment. What would you like prayer for?

Have you received healing prayer before?

Yes No

If you answered yes to the last question, is there anything you think your prayer team needs to know from that time(s)? (It can be helpful to know if you have already received healing in certain areas or if you feel there is more healing needed)

Are you comfortable with a mixed gender team?

Yes No

Do you trust in Jesus Christ as your Lord and Savior?

Yes No Uncertain Would appreciate more information

If you are a member of a church other than Gold Avenue Church:

My pastor is aware that I am receiving prayer ministry through Gold Avenue church. Yes No

I give permission for the prayer team to discuss my prayer appointment with my pastor for the purposes of continuing care and support Yes No

Pastor's name:

Pastor's email:

Pastor's phone:

Availability

Please let us know days (Monday, Tuesday, Wednesday, Thursday, Friday) and times (morning/ afternoon/ evening) that you may typically be available for a prayer appointment. We desire to give the Lord space to heal in an unhurried and relaxed atmosphere, so we usually schedule a 2 hour time slot for your appointment.

My Typical Availability

Statement of Understanding and Consent

I understand that I voluntarily consent to be ministered to and prayed for by encouragers and prayer partners and that they are helping me work through some personal and spiritual issues. I understand that they are not professional counselors, but encouragers and prayer partners.

I understand that I am free to leave at any time and am here voluntarily. I understand that I am under no financial obligation. I am also aware of my right to ask for clarification on any part of this form.

I am aware that the prayer partners meeting with me may need to intervene or contact appropriate authorities if they feel that I am a potential risk to myself or others, or at risk myself from others.

I understand that I am not being advised to alter any medication I am currently taking. That is a matter between myself and my physician or therapist.

I understand that some or all of the procedures used by the prayer team may or may not be clinically demonstrated or guaranteeing either short or long term results. I fully understand that the ministry I receive is NOT counseling in any form but rather encouragement and prayer ministry. I accept this ministry fully and completely and do not hold anyone responsible for ANY outcome that may arise as a result of this ministry.

I hereby certify that I and my family, estate, and all assigns, will assume personal responsibility for and will hold harmless the prayer partners and their assigns and estates and Gold Avenue Church and its assigns, officers, directors, employees and any parties volunteering on behalf of Gold Avenue Church for all actions, costs, expenses or damages of any kind growing out of or related to the prayer ministry provided to me by the prayer partners.

Please check here to affirm and agree with all of the above statements.

I Agree

Gold Avenue Church Prayer Ministry Request Form

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