Connect Up Session

Please fill out this form to request a ConnectUp prayer ministry appointment. Sessions are currently offered online via google meet or in person if you are local in Ithaca NY area. Once your application is reviewed you will receive instructions for your next steps via email.

Your name *

Email address *

Are you requesting an in person or Google Meet Connect Up Session?

Full Address

Phone Number *

Gender:

Female

Male

Age:

Must be older than 18

How did you hear about Thrive Regional ConnectUp?

If you said other, please explain.

Friend

Thrive

Internet

Other

Are you currently under the care of a psychiatrist, psychologist, therapist or licensed counselor?

Have you received prayer ministry for emotional healing or counseling before? If yes, enter the date and context of your last session.

Why would you like to receive ministry through ConnectUp? Are there are specific areas you are seeking breakthrough in?

Shared Understanding *

The following section outlines some important things in which we want to have a shared understanding.

To comply with EU/UK GDPR rules on special-category (religious-belief) data, we are sharing our Privacy Policy and ask for your explicit consent for ConnectUp to process your application - including any faith-related information - for the purpose of facilitating these programs you are seeking. We have also provided a communications consent and liability release form.

Yes, I agree to ConnectUp processing my application data including any faith-related information.

Text Reminders

Yes, I agree to receive text messages from ConnectUp for my appointment. (Message & data rates may apply. Reply STOP to unsubscribe, HELP for help.)

Liability Release Form *

The purpose of this ministry is for spiritual growth and healing. It is not a psychological counseling service, nor is it intended to be. Team members are not licensed psychologists or psychiatrists; however, they are trained in using the Word of God and prayer through the power of the Holy Spirit. The results of this approach depend on the willingness of the individual to make wise choices consistent with the teachings of Jesus Christ.

All personal information gathered in the course of a ministry session is confidential, and the files are so maintained; however, information, as needed, may be shared with leaders of ConnectUp, Inc. to further my healing process. ConnectUp, Inc. prayer ministers may consult with other ConnectUp, Inc. team members without the use of individuals’ names. Discipleship, the commitment to train others in the mastery of prayer ministry skills, is an ongoing aspect of prayer ministry. Qualified disciples may be assigned during ministry sessions. The adherence to a strict policy of confidentiality includes disciples working with prayer ministers.

ConnectUp will abide by all laws regarding the reporting of threats to self, threats to others, abuse of a child, abuse of the elderly and/or other behavior deemed by ConnectUp to be harmful to yourself or others. Regardless of local laws, and out of care and respect for God’s creation, ConnectUp will report any of the above to the proper authorities.

ConnectUp will leverage technology including, but not limited to, Zoom and other video conferencing platforms. ConnectUp is neither responsible nor liable for the use of this technology or any issues related to the privacy and security of such technology. None of the participants will record any session unless all participants agree to the same.

I understand the above information concerning this ministry. I have sought this ministry of my own free will and 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. All personal information I reveal is given voluntarily in order to facilitate the team members working with me. I further release ConnectUp, Inc. from any and all liability, loss or damage of any kind that may arise or result from these ministry sessions.

I also consent to receiving email and text message communications from ConnectUp to assist in the coordination of my ministry session, typically 2 reminder text messages. Message and data rates may apply. I can text STOP to unsubscribe.

Please fill in your full name below to acknowledge that you have read the Liability Release Form and that you acknowledge and accept the guidelines stated above.