CITYGATE HRM PATIENT REGISTRATION FORM
CITYGATE HEALING ROOMS MINISTRY  
Contact:    +65 92177246  (SMS or WHATSAPP only)
Email: healingroom@citymissionschurch.org

ACKNOWLEDGEMENT
After you submit your completed registration form, you will receive an Acknowledgement as indicated below:
YOUR REGISTRATION IS SUCCESSFUL. FOR ZOOM MINISTRY, OUR MINISTRY TEAM WILL SEND THE ZOOM LINK AND INFORM YOU THE DATE FOR YOUR MINISTRY SESSION. FOR ONSITE MINISTRY, PLEASE COME TO THE CHURCH PREMISES @ 7PM ON MONDAY. SHALOM. CITYGATE HEALING ROOMS MINISTRY TEAM.
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1. Full Name (First Name and Surname) *
2. Mobile Contact *
3. Email Address *
4. Gender *
5. If Minor (under age of 18years old). Please provide Parent name and mobile
6A. Information Required (Please TICK all that is applicable)
6B. I am attending this Church *
7. I am requesting for prayers (Please TICK all that is applicable) *
Required
8. Provide details to Item 7 above
9. Language preferred
Legal Liability Release:    I acknowledge that I have of my own free will, come to the Healing Rooms Singapore ("HRS" ) which is under the spiritual cover of City Missions Church for ministry. I accept that HRS is a Ministry of the Holy Spirit, and that the volunteers are not trained or licensed administrative, medical or counseling  professionals and that the ministry I received may involve my being ministered on in any one or more of the following ways: (1) prayers for physical healing; (2) prayers for inner healing ; and (3) prayers for deliverance from spiritual bondages and circumstances.  In consideration of you acceding to my request for ministry,  I hereby agree to release, hold harmless and indemnity HRS ( its successors and assigns) and its volunteers against all suits, actions, claims, losses and damages sustained or perceived to be sustained by me.   Where applicable, I warrant that my signature below shall be taken as having executed this release and indemnify as the legal guardian of the minor named, for whom I have requested ministry. *
Signature (Please print this form and sign below). However, if you are unable to print the form to sign, please type your name below as indication of your signature. During the online session, C.HRM administrator will record your verbal consent before proceeding with your ministry session. *
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