4301 N College St
Newberg, OR 97132
503-538-2283
Church Office
admin@rockpt.org
prayer@rockpt.org
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SOZO Ministry
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Name
*
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*
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*
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*
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*
Date Format: MM slash DD slash YYYY
Age
*
Name of Parent or Guardian
*
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*
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*
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Who referred you to the SOZO ministry?
Have you a received SOZO before?
*
Yes, at RockPoint
Yes, at Another Location
No, I Have Not
Why would you like to receive a SOZO?
*
Have you received counseling from your church or a licensed counselor?
*
Yes
No
With Whom?
*
Do you have a home church?
*
Yes
No
Name of Home Church
*
Do you have a leadership role in your home church?
*
Yes
No
What is your leadership role?
*
Check All That Apply
*
Anxiety
Headaches
Depression
Sleep Disturbance
Increased/Decreased Appetite
Recent Loss
Drug Abuse
Alcohol Abuse
Suicidal Thoughts
Sexual Orientation Confusion
Sexual Promiscuity
Pornography
Excessive Anger
Occult Involvement
Liability Release for RockPoint Church SOZO Ministry. I acknowledge that team members from the SOZO Ministry of RockPoint Church have voluntarily agreed to pray for me. I understand this session is not a professional counseling meeting and none of the team members are licensed counselors. I understand these team members are, to the best of their ability, doing what they can to help me achieve more freedom in my life. I understand RockPoint Church, Newberg is a nonprofit Oregon Corporation that makes no charge for its services (*although a donation of $60 is suggested). I further state that I have voluntarily sought assistance of my own initiative and that I am under no obligation to accept or reject any of the advice or help that I might receive from the team members of this ministry. I understand that if I receive ministry from the RockPoint SOZO Ministry, the team is committed to respect the disclosed information, but not to complete confidentiality. The information, as needed, may be shared with other leaders of the SOZO Ministry so as to further my total healing process. This may include future meetings with spiritual mentors in the church to set appropriate guidelines for my spiritual growth. I agree to hold RockPoint Church and its SOZO team members and pastors free from any and all liability, loss, or damage of any kind that may arise as a result of assistance which I have received or from my involvement with RockPoint Church.
*
I have read, understand, and agree to this release form