Freedom Worship Center e.V.
Application For Prayer Ministry
Application for Healing & Restoration Prayer Ministry
page 1 of 2
Name: *
required
First Name
Last Name
Address: *
required
International Address
Phone: *
required
Phone Number
Email *
required
Email Address
Age:
required
Gender: *
select one
Select from list
select one
Male
Female
Primary Language(s) Spoken: *
select one
Select all that apply
Deutsch
English
French
Russian
Spanish
Marital Status: *
select one
Select from list
select one
Single
Married
Separated
Divorced
Widowed
Annuled
Cultural, Ethnic Background *
required
Have you repented of your sins and asked Jesus to save you? *
select one
Select from list
select one
Yes
No
Not Sure
Have you been water baptized by emersion? *
select one
Select from list
select one
Yes
No
Not Sure
I was baptized as a baby
Do you attend church regularly? *
select one
Select from list
select one
Do not attend church
Weekly
Monthly
Special Occasions
Do you tithe /give offerings regularly? *
select one
Select from list
select one
Yes
No
Sometimes
Church Affiliation/ Name and location: *
required
Current Pastor's Name
required
When can you be available to meet? (please check all that apply) *
select one
Select all that apply
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Mornings
Afternoons
Evenings
Application for Healing & Restoration Prayer Ministry (Continued)
page 2 of 2
What led you to us for assistance/information? *
required
Please give as much detail as to why you are seeking special prayer for healing. *
required
Are you willing to follow all instructions given for this process to work? *
select one
Select from list
select one
Yes
No
Not Sure
* required
