REQUEST FOR DELIVERANCE FORM
The information that you provide is strictly confidential and will be viewed only by the individual(s) involved in personal ministry with you. Please fill out this form and sign the liability waiver at the bottom. Write N/A (Not Applicable) in any area that does not apply to you. If you are unable to remember names and specifics, I pray the Holy Spirit will bring everything to remembrance in response to your faith and search for freedom.
Email *
Today's Date: *
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First Name: *
Last Name: *
Date of Birth: *
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Address *
Phone Number *
What is your relationship status? *
Have you COMMITTED your life to following Jesus Christ as your Lord & Savior? *
Have you received your heavenly prayer language? *
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