Restoration at Life

I would like to schedule a Restoration at Life session

Your name *

Email address *

Phone number *

Can we text the above number? *

Birthday *

Gender *

Address *

What church do you currently attend? *

Pastor's name? *

Who referred you to get a Restoration session? *

Why would you like to receive a Restoration session? *

Are you applying for a Restoration session as a requirement for Life Church leadership? *

Are you presently or have you in the past, received ministry and/or counseling? *

If yes, with whom, and the approximate date of the last session.

Do you currently attend a Life Group? *

Will you be able to fast and pray the week before your Restoration session? *

Before you fast, ask Holy Spirit what He wants you to do. There are a variety of ways to fast

Will you ask two people to pray for you while your session is in progress? *

Liability release for Life Church, Fort Myers

I acknowledge that team members from Life Church, Fort Myers, have voluntarily agreed to pray for and minister to me. 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 freedom in my life. I understand that Life Church, Fort Myers, is a non-profit Florida Corporation that makes no charge for its services and its team members offer biblical spiritual ministry to anyone. I further state that I have voluntarily sought the assistance of my own initiative and that I am under no obligation to accept or reject any of the advice or help that I might receive from the team members of this ministry. I understand that if I receive ministry from Life Church, the Team is committed to confidentiality, except for ministry to individuals in a committed relationship with Life Church. In this case, the information, as needed, may be shared with other leaders of Life Church so as to further my total healing process. This may include future meetings with spiritual mentors in the church to set appropriate boundaries for my personal and spiritual growth. I also understand that Life Church mandatorily reports child and elder abuse to the proper authorities. I agree to hold Life Church, Fort Myers, and its team members free from any and all liability, loss, or damage of any kind that may arise as a result of assistance, which I have received or from my involvement with Life Church, Fort Myers.

I agree to the above Liability Release *