Name

First Name

Last Name

Contact number

This is useful if we need a quick response/change of appointment.

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Gender

Church attending (if any)

Reason for Sozo

How did you hear about Sozo?

Have you had a Sozo before?

If yes, when and where?

Any additional information you would like us to know?

Please indiciate all the times that would suit you. We offer morning, afternoon or evening slots everyday except Monday (no times available) and Sunday (morning not available).

You will normally have a Sozo with two of the same gender as yourself but at times the team is mixed. Please confirm whether you are happy to have a mixed team.

Waiver of Liability Form for SCF Sozo Ministries. I acknowledge that team members from the above ministries have voluntarily agreed to pray for me. I accept that these team members are, to the best of their ability, ministering to me to achieve more freedom in my life. I understand that the session is not a professional counselling meeting and that none of the team members are licensed counsellors. I have sought assistance voluntarily and I am under no obligation to accept or reject any of the advice or help that I might receive in the session. I am aware that all the statements I shall make to the Team members are of a confidential nature, including all written information, and that legally and ethically these may not be disclosed without my written consent. I am also aware that any written information will not be retained after my course of ministry is completed. However, I waive my right to ‘complete’ confidentiality in the following situations: I accept that the person ministering may share a summary report of the session with a member of the oversight team in order to further my healing process. This process may include further meetings with spiritual mentors/my Minister where I have accountability to set appropriate boundaries for my personal and spiritual growth. I acknowledge that Pastors/Leaders in any area of church life or any person involved with working with adults and children in a helping setting are either encouraged or required by law to disclose to the appropriate person or agency or civil authority any harm, or potential harm, that a person may attempt or desire to do to one’s self or to others. I acknowledge that the Pastors/Leaders in any area of church life are also required to report any reasonable suspicion of any form of abuse which may have involved myself and a child under 16, or an adult with care and support needs. I accept that the Pastors/Leaders at Southend Christian Fellowship reserve the right to make such reports as mandated by law whether or not they confer with me first. I agree to hold Southend Christian Fellowship and its team members free from any and all liability, loss or damage of any kind that many arise as a result of assistance which I have received or my involvement in SCF. By signing my digital signature below I acknowledge that I have read and understand the Waiver of Liability and of Confidentiality and agree with it and have executed it as my free and voluntary act.

Date

Suggested Donation: £10-£25, to be enclosed with this form.

SCF bank details for online payment: 20-04-96 90985570

Please email sozo@southendchristianfellowship.org.uk to let us know you have donated in this way.

(NB: We would not wish financial difficulty to prevent your having a Sozo. If this is the case, please let us know).