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Prayer Mountain Consent Form 

Phone

470-822-0741

Email

Kingdonadvancers814@gmail.com

Personal Information

Emergency contact Info

Medical Restrictions/Allergies

Are you allergic to any foods?
Do you take any medications regularly?
Do you have any medical restrictions?
Are you allergic to any medications?

Consent

(For the following please check Yes or No.)

I give Kingdom Advancers permission to use any photographs and/or videos taken of me at Prayer Mountain 2024 for any online releases, publications and any other communications related to the mission of Kingdom Advancers.

Yes OR No

I give Kingdom Advancers permission to partake in any deliverance on me during Prayer Mountain.

Yes OR No

I agree that I am coming to Prayer Mountain at my own risk and that I do not hold Kingdom Advancers liable for anything.

Yes OR No

I agree that I am responsible for all of my personal belongings.

Yes OR No

I agree that I have answered the following questions to the best of my knowledge.

Yes OR No
Electronically sign first and last name

Thanks for submitting!

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