Registration Entry

ConnectUp Ministry Application - Crossroads Church

Please fill out this form to request a ConnectUp prayer ministry appointment. Sessions are currently offered in person at any of the four Crossroads locations (North, Ohio Valley, South, West) or online via zoom. Once your application is reviewed, you will receive instructions for your next steps via email.

First Name

Last Name

Mobile Phone

Gender

Male Female

Address

Marital Status

Age (must be 18 years or older)

How did you hear about ConnectUp Crossroads Church?

Have you received prayer ministry for emotional healing before? If yes, enter the date and context of your last session.

Are you currently under the care of a psychiatrist, psychologist, therapist, or licensed counselor?

Why would you like to receive ministry through ConnectUp? Are there any specific areas you are seeking breakthrough in?

Where would you like to receive your prayer ministry?

Liability Release Form

The purpose of this ministry is for spiritual growth and healing. It is not a psychological counseling service, nor is it intended to be. Team members are not licensed psychologists or psychiatrists; however, they are trained in using the Word of God and prayer through the power of the Holy Spirit. The results of this approach depend on the willingness of the individual to make wise choices consistent with the teachings of Jesus Christ.

All personal information gathered in the course of a ministry session is confidential, and the files are so maintained; however, information, as needed, may be shared with leaders of ConnectUp Crossroads Church to further my healing process. ConnectUp Crossroads Church prayer ministers may consult with other ConnectUp Crossroads Church team members without the use of individuals’ names. Discipleship, the commitment to train others in the mastery of prayer ministry skills, is an ongoing aspect of prayer ministry. Qualified disciples may be assigned during ministry sessions. The adherence to a strict policy of confidentiality includes disciples working with prayer ministers.

ConnectUp Crossroads Church will abide by all laws regarding the reporting of threats to self, threats to others, abuse of a child, abuse of the elderly and/or other behavior deemed by ConnectUp Crossroads Church to be harmful to yourself or others. Regardless of local laws, and out of care and respect for God’s creation, ConnectUp Crossroads Church will report any of the above to the proper authorities.

ConnectUp Crossroads Church will leverage technology including, but not limited to, Zoom and other video conferencing platforms. ConnectUp Crossroads Church is neither responsible nor liable for the use of this technology or any issues related to the privacy and security of such technology. None of the participants will record any session unless all participants agree to the same.

I understand the above information concerning this ministry. I have sought this ministry of my own free will and 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. All personal information I reveal is given voluntarily in order to facilitate the team members working with me. I further release ConnectUp Crossroads Church from any and all liability, loss or damage of any kind that may arise or result from these ministry sessions.

Please populate the fields below to acknowledge that you have read the Release Form and that you acknowledge and accept the guidelines stated above.

Please type your name below to acknowledge that you have read the Release Form and that you acknowledge and accept the guidelines stated above.

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