Request for Sozo Ministry Session

First Name

Last Name

Email

Phone Number

Gender

Are you 18 or older?

Yes

No

If you are under the age of 18, how old are you?

Parent First Name

Parent Last Name

Parent Signature

Time of day to meet

Time of week

What other things are you struggling with?

To proceed, we kindly request that you carefully review the terms and conditions.

Release of Liability

I do hereby release Canyon View and any of its
staff, leaders and volunteers, from any harm or perceived harm resulting from
my voluntary receiving of free prayer on this and subsequent visits. I
understand that this ministry is provided by a volunteer staff representing the
body of Jesus Christ. They are not trained, licensed medical professionals;
psychological counselors; or therapists. They do not provide medical or psychological services.

I acknowledge that I need to seek advice from my medical doctor/therapist/counselor/any other professionals to confirm any
results of prayer received before altering any prescribed course of action.

I understand this form & all data recorded on it is the sole property of Canyon View. All content will be held in confidence for the sole purpose of the ministry unless I give permission for such things to be shared.

Signature