Name *

First Name

Last Name

Phone Number *

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Spouse's Name

Please type "NA" in each text box if not applicable.

First Name

Last Name

Will you be attending the conference with a child or children? *

Please be advised that children ages 0-12 are free, children ages 13-17 require a cost of $125 per child.

Yes

No

Childcare Liability Acknowledgement *

I acknowledge that childcare will not be provided at the GIANTS FALL Deliverance Conference and I assume responsibility for the well-being of my child or children attending the conference with me.

NA (I am not bringing a child with me to the conference)

Consent and Media Acknowledgement: *

I hereby affirm and state that I consent for Blaze Deliverance Ministry and all volunteers working with the ministry to minister to me in the area of spiritual counselling, personal ministry and deliverance, using the bible as our foundational resource. I understand and acknowledge that all Blaze Deliverance ministers, licensed and lay, involved may or may not be trained as professional counselors, psychotherapists and mental health professionals. I understand that all guidance,counsel and advice that I receive is solely based on Christian biblical standards and spiritual principles, as defined by the Holy Bible. I understand and acknowledge that this ministry is under the direction and control of the Holy Spirit and that no guarantees are made and can be made, with regard to my breakthrough, healing and deliverance. I understand the nature of my request for services and have voluntarily sought ministry services through Blaze Deliverance Ministry and hereby release Blaze Deliverance Ministry and all its volunteers from any and all claims of an actual or implied liability that may arise now or in the future as a result of the ministry I received.

Media Acknowledgement *

I acknowledge that my photo and video might be taken and used on BDM's website and social media platforms for promotional or ministry purposes.

Emergency Contact Information: *

First Name

Last Name

Phone *

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