Freedom House Church and Healing Centre

APPLICATION FOR MINISTRY

• • Your Name*
    First Name

    Last Name
  • Address*
    Street Address*

    Address Line 2

    City*

    Province / State / Region*

    Postal Code / Zip

    Antigua and BarbudaBahamasBarbadosBelizeCanadaCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNicaraguaPanamaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited StatesArgentinaBoliviaBrazilChileColumbiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuelaAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican CityAfghanistanBahrainBangladeshBhutanBrunei DarussalamMyanmarCambodiaChinaEast TimorIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPhilippinesQatarRussiaSaudi ArabiaSingaporeSri LankaSyriaTaiwanTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemenAustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatuAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral African RepublicChadComorosCongoDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGuineaGuinea-BissauCôte d\'IvoireKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSudanSwazilandTanzaniaTogoTunisiaUgandaZambiaZimbabwe

    Country*
  • Phone*
     

    (###)

    -

    ###

    -

    ####
  • Your Email
     
  • Date of Birth*
    MM

    DD

    YYYY
  • Sex*
    >- Select One -MaleFemale
  • Marital Status*
  • Are you currently attending a church?*
    Yes

    No

    Occasionally
  • Name of the Church you are attending:*
  • How often do you attend?*
  • Name of your minister/pastor/leader*
  • Does the church leadership know that you have applied to Freedom House?*
    >- Select One - YesNoI will be notifying themI don't know
  • Address and contact information of the Church (*we will only contact said person with your permission)*
    Street Address*

    Address Line 2

    City*

    Province / State / Region*

    Postal Code / Zip

    Antigua and BarbudaBahamasBarbadosBelizeCanadaCosta RicaCubaDominicaDominican RepublicEl SalvadorGrenadaGuatemalaHaitiHondurasJamaicaMexicoNicaraguaPanamaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesTrinidad and TobagoUnited StatesArgentinaBoliviaBrazilChileColumbiaEcuadorGuyanaParaguayPeruSurinameUruguayVenezuelaAlbaniaAndorraArmeniaAustriaAzerbaijanBelarusBelgiumBosnia and HerzegovinaBulgariaCroatiaCyprusCzech RepublicDenmarkEstoniaFinlandFranceGeorgiaGermanyGreeceHungaryIcelandIrelandItalyLatviaLiechtensteinLithuaniaLuxembourgMacedoniaMaltaMoldovaMonacoMontenegroNetherlandsNorwayPolandPortugalRomaniaSan MarinoSerbiaSlovakiaSloveniaSpainSwedenSwitzerlandUkraineUnited KingdomVatican CityAfghanistanBahrainBangladeshBhutanBrunei DarussalamMyanmarCambodiaChinaEast TimorIndiaIndonesiaIranIraqIsraelJapanJordanKazakhstanNorth KoreaSouth KoreaKuwaitKyrgyzstanLaosLebanonMalaysiaMaldivesMongoliaNepalOmanPakistanPhilippinesQatarRussiaSaudi ArabiaSingaporeSri LankaSyriaTaiwanTajikistanThailandTurkeyTurkmenistanUnited Arab EmiratesUzbekistanVietnamYemenAustraliaFijiKiribatiMarshall IslandsMicronesiaNauruNew ZealandPalauPapua New GuineaSamoaSolomon IslandsTongaTuvaluVanuatuAlgeriaAngolaBeninBotswanaBurkina FasoBurundiCameroonCape VerdeCentral African RepublicChadComorosCongoDjiboutiEgyptEquatorial GuineaEritreaEthiopiaGabonGambiaGhanaGuineaGuinea-BissauCôte d\'IvoireKenyaLesothoLiberiaLibyaMadagascarMalawiMaliMauritaniaMauritiusMoroccoMozambiqueNamibiaNigerNigeriaRwandaSao Tome and PrincipeSenegalSeychellesSierra LeoneSomaliaSouth AfricaSudanSwazilandTanzaniaTogoTunisiaUgandaZambiaZimbabwe

    Country*
  • Phone*
     
• • Have you ever, or are you currently receiving ministry from your church?
    Yes

    No

    Not Sure
  • Please give details:
  • Is there someone who can help you after your visit at Freedom House? *
    Yes

    No

    Not Sure
  • Please give details:
  • Please, briefly share your salvation experience:
  • Are you currently being mentored/discipled?
  • Are you currently part of a small group?
  • Are you experiencing difficulty with any of the following:
    Marriage Partner

    God

    Children

    Church

    Sexual Problem

    Authority

    Other (please specify below)
  • Other:
  • In what areas of your life do you feel you need prayer? Please check all that apply, and give brief detail.
    Physical Healing
  • Details
  • Mental Stress
  • Details:
  • Emotional Hurt
  • Details:
  • Fears
  • Details:
  • Addictions
  • Details:
  • Trauma
  • Details:
  • Other
  • Details:
  • Have you been involved in the occult? (witchcraft, horoscopes, Ouija boards, false sects, etc)?
    Yes

    No

    Not Sure
  • Please give details
  • Have you received, or are you currently receiving medical/psychiatric help concerning your present needs?
    Yes

    No

    Not Sure
  • Please give details, including any medication your doctor has prescribed):
  • Please give us any other info that may help assess your needs (including previous healing ministry).
  • With your permission only, are you willing for your doctor, psychiatrist or minister to share any necessary information with us?
    Yes

    No
  • Any other questions/comments/concerns?
• 1. All information you fill out will be kept strictly confidential, and stored in a locked filing cabinet. Only those directly involved with you will see this information.
• 2. Healing is God's work. Some may report instantaneous healing and deliverance after ministry, while others may experience gradual healing. We encourage you to keep coming for prayer ministry until your healing is complete. We will always welcome you back for further ministry. It is also very beneficial to learn to walk out your healing with biblically sound discipleship, and mentoring. Please speak to us about what we offer to help you achieve the abundant life God has for you, in Christ Jesus our Lord.
• 3. We are obligated to report to the authorities confessions of a criminal nature.
  • Release of Liability: I hereby release Freedom House Church and Healing Centre, its staff, agents and volunteers from any liability whatsoever arising out of any damage or loss sustained by said persons during the course of my involvement with Freedom House Church and Healing Centre.*
  • Date*
    MM

    DD

    YYYY
• 
  Submit