EmailMe Form - Healing Ministry Application

Date of Application *

MM / DD / YYYY

Have you paid the $30 application fee? *

Yes

No

If yes, enter Eventbrite confirmation number here: *

What type of Sozo session would you like? *

In Person

Virtual (global missionaries only)

*Virtual sessions are currently only available for oversea and out of state missionaries.

Name *

First Last

Address *

Street Address City State / Province / Region Postal / Zip Code

Email *

Primary Phone *

### - ### - ####

Secondary Phone

### - ### - ####

Can we text you? *

Yes

No

Age *

Gender *

Male

Female

Marital Status *

Single

Married

Divorced

Widowed

Emergency Contact Information:

Emergency Contact #1
Name: *

First Last

Cell Phone *

### - ### - ####

Home Phone

### - ### - ####

Relationship to you: *

Emergency Contact #2
Name:

First Last

Cell Phone

### - ### - ####

Home Phone

### - ### - ####

Relationship to you:

Please answer the following questions:

*

Do you have children?
How many?
Ages

If No, type N/A

What church, if any, do you attend?
How long have you been attending?

If No, type N/A

Are you currently serving in a WOL ministry? *

Yes

No

Are you WOL Staff? *

Yes

No

Referrals *

Who referred you to the Sozo ministry?

Have you completed Water of Life's Living Waters Class and Retreat? *

Yes

No

(NOTE: Living Waters is recommended for those requesting a Sozo prayer session. Please email Laurel Hall for class information at livingwaterswol@gmail.com.)

Are you part of a small group? *

Yes

No

What do you need help with in your Sozo session? Check those that apply below: *

Deal with emotional/physical distress

Deal with demonic activity

Deal with physical illness

Meet WOL ministry requirement

Meet requirement for mission trip

Get closer to God

Other - Use box below

If you chose other, please explain:

If you checked any of the first three items, indicate how long you have experienced these issues.

Duration: *

Emotional/physical distress
Demonic activity
Physical illness

If it does not apply, type N/A

Please rate your current level of distress related to the above issue(s) using a 1- 5 rating scale with 1 being low distress and 5 being high level of distress:

Scale of 1-5: *

Emotional Distress Level
Physical Distress Level
Impact on Relationships
Impact on Your Current Quality of Life

What have you already done to address this (or these) issue(s) at Water of Life?

Pastoral Care

Counseling

Healing Rooms

Other

If you chose other, please explain:

What have you already done to address this (or these) issue(s) outside of Water of Life?

Care under a psychiatrist

Care under a therapist

Other

If you chose other, please explain:

Sozo prayer sessions will be scheduled on Tuesday evenings at 7:00pm or Saturday mornings at 9:00am. Check all that apply: *

Tuesday (Women only)

Saturday

Note to Sozo Ministry:

As soon as your paperwork is received, we will contact you and place you into the queue for the next available appointment.

LIABILITY RELEASE FOR WATER OF LIFE COMMUNITY CHURCH SOZO MINISTRIES

Please read and sign the Liability Release:

I, (Enter Name) *

acknowledge that team members from Water of Life Community Church Sozo Ministries have voluntarily agreed to pray for me either in an “in-person” session or “virtually” using a password protected video platform. I understand that this session is not a professional counseling meeting and that none of the team members are licensed counselors. I understand that these team members are, to the best of their ability, doing what they can to help me achieve more spiritual freedom in my life.

I understand that Water of Life Community Church is a religious nonprofit California Corporation that makes no charge for its services and that the Sozo application fee is a suggested donation. I further state that I have voluntarily sought assistance of my own initiative and that I am under no obligation to accept or reject any of the help that I might receive from the team members of this ministry.

I understand, am aware of, and assume all risks inherent in participating in the Water of Life Community Church Sozo Ministries. These risks include, but are not limited to, physical and emotional responses and reactions because of this prayer ministry.

I understand that, if I receive ministry from Water of Life Community Church Sozo Ministries, the team is committed to respect the disclosed information, but not to complete confidentiality. The information, as needed, may be shared with other leaders of Water of Life Community Church Sozo Ministries to further my healing process. This may include future meetings with spiritual mentors in the church to set appropriate boundaries for my personal and spiritual growth.

Further, I, the participant, release and promise to indemnify, defend and hold harmless Water of Life Community Church Sozo Ministries, Water of Life Community Church, and its staff and Sozo team members free from any and all liability, loss, damage or injury of any kind arising directly or indirectly as a result of the assistance which I have received or from my involvement with Water of Life Community Church Sozo Ministries, whether such liability, loss, damage or injury arise out of the negligence of this ministry, myself as the participant, or otherwise.

Initial here

I have read this disclaimer and release of liability and understand and agree with it and have executed it as my free and voluntary act.

Please Sign *

Clear

SIGNATURE ABOVE

Initial Below *

Date *

MM / DD / YYYY