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Personal Ministry In-Take Form

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Tell us about yourself

Have you received a Personal Mininstry session before?
Are you currently seeing a Therapist/Counselor?
Please place a check next to any of the following that currently apply to you.

In consideration for being permitted to participate in voluntary prayer ministry, herein referred to as the "Prayer Ministry," the undersigned,  , herein referred to as the "Releaser," agrees as follows:

 

 

1.   RELEASE, WAIVER, DISCHARGE AND COVENANT NOT TO SUE.  Releaser and Releaser's personal representatives, assigns, insurer, heirs, executors, and administrators, spouse and next of kin, hereby releases, waives, discharges and covenants not to sue Pathway to Freedom Ministries, located at 206 Harvard Dr., Princeton, Texas 75407, and its directors, officers, employees, agents, volunteers as well as its successors, assigns, affiliates, subordinates, and subsidiaries, all herein referred to as the "Releasees," from any and all liability to Releaser,  and to Releaser's  personal representatives, assigns, insurers, heirs, executors, administrators, spouses and next of kin for any and all loss, damage, or cost on account of injury to the person or property or resulting in the death of Releaser, whether caused by the negligence of Releasees or otherwise while Releaser is participating in the Prayer Ministry and any other activities in connection with the Prayer Ministry. 

 

2.   ASSUMPTION OF RISK. Releaser understands, is aware of, and assumes all risks inherent in participating in the Prayer Ministry. These risks include, but are not limited to, physical and emotional responses and reactions as a result of this prayer ministry. 

 

3.   INDEMNITY.  Releaser agrees to indemnify Releasees from any liability, loss, damage or cost Releasees may incur due to the participation by Releaser in the Prayer Ministry whether caused by the negligence of Releasees or otherwise.  Releaser assumes full responsibility for and risk of bodily injury, death or property damage due to negligence of Releasees or otherwise while participating in the Prayer Ministry. 

 

      Releaser expressly agrees that this Voluntary Release, Assumption of Risk and Indemnity agreement, herein referred to as "Agreement," is intended to be as broad and inclusive as permitted by the laws of the State of Texas and that, if any portion of this Agreement is held invalid, it is agreed that a balance, notwithstanding, continue in full legal force and effect.  This Agreement contains the entire agreement between the parties in regard to the Prayer Ministry. 

 

      RELEASER REPRESENTS THAT:

 

      I HAVE CAREFULLY READ THIS AGREEMENT.  I UNDERSTAND IT IS A RELEASE OF ALL CLAIMS, INCLUDING THE NEGLIGENCE OF RELEASEES. 

 

      I UNDERSTAND THAT I ASSUME ALL RISKS INHERENT IN THE PRAYER MINISTRY SET FORTH IN THIS AGREEMENT. I UNDERSTAND THAT I AM INDEMNFYING THE RELEASEES. 

      

      I VOLUNTARILY SIGN MY NAME EVIDENCING MY UNDERSTANDING AND ACCEPTANCE OF PROVISIONS OF THIS AGREEMENT.

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