Augusta Healing Rooms Prayer Request Form

I, the undersigned do hereby release Healing Room Ministries, the Augusta Healing Rooms and their volunteers or staff from any liability, for any harm or perceived harm resulting from my voluntary receiving of free prayer on this and subsequent visits. I understand that these Healing Rooms are staffed by volunteers representing the body of Christ, and reflecting many denominations and churches. They are not trained or licensed professionals of counseling, therapy or medical services. I understand that if I am currently taking medication, or operating under the advice of a professional service, I will allow them (my medical doctor, therapist, counselor etc.) to confirm any results of prayer received before altering any prescribed course of action. I understand that this form and all data recorded on it is the sole property for Augusta Healing Rooms and Healing Rooms Ministries. All content will be held in confidence for the sole purpose of my individual ministry.

  • We will contact you at this email address to schedule your appointment.
  • Provide a brief description of your prayer needs.
  • Any person entering the premises waives all civil liability against this premises owner and operator for any injuries caused by the inherent risk associated with contracting COVID-19 at public gatherings, except for gross negligence, willful and wanton misconduct, reckless infliction of harm, or intentional infliction of harm, by the individual or entity of the premises
  • By typing your name here, you are digitally signing to agree with the above liability release. Must be 18 years of age or older.