Bethel Testimony Form

Testimony Form

Thanks for spending 7mins to record your testimony and shape the future of the planet!

First Name: *

Last Name: *

Contact Phone: *

Email: *

Date of Miracle: *

What is Your Connection with Bethel Church? *

Please Explain: *

Name of Your Department: *

Name of Conference Attended: *

BSSM Class *

1st Year Student

2nd Year Student

3rd Year Student

Volunteer

Who is your revival group pastor (RGP)? Please list first and last name, as well as making note of co-leaders if applicable. *

Where did the miracle take place? *

Name of mission/ministry trip *

Please Choose Which Itinerant Pastor/Team You Received Ministry From *

Please Check Any That Apply: *

I have a medical report

I have an eye-witness

I have a video and/or photograph to support

It was just Jesus and me

Description of Your Testimony:

What was the need/problem? What happened? What changed? What did you learn about God?

*

On the scale below, please choose your pain level before you were ministered to. 1 being slight pain and10 being severe pain. *

On the scale below, please choose your pain level after you were ministered to. 1 being slight pain and10 being severe pain. *

Are you in the care of a professional service? *

Medical Doctor

Counselor

Other: Other:

How long have you had this issue? *

Which area of society would your testimony 'influence' or 'relate to'?

eg. Prayed for my boss at work who then as a result got family restoration = family mountain & business mountain

*

Tags

Please choose all that apply

Miracles:

Physical Healing:

Spiritual:

Baptism Holy Spirit

Manifest presence/glory

Revelation insight

Salvation

Inner Healing

Prosperity:

Additional Tags:

Permission to Share: *

Yes I am happy to be contacted and for this testimony to be used in any productions by BSSM & Bethel Media

I have read the Bethel Media Waiver form below and I agree to the terms of the waiver as it applies to any reproduction of my testimony by Bethel Media.

I would prefer that this testimony be kept confidential

My contact phone number is: *

May Bethel Healing Rooms Staff contact you to follow up regarding this visit? *

Yes please

No, thank you

Media Participation

Waiver and Release Form

I hereby give my permission to Bethel Church and any associated organizations or contractors to photograph, videotape, record testimonies and/or otherwise make recordings of me (including name, face, likeness, appearance and/or voice) for any legitimate use without limitation or reservation. I understand that these recordings may be used for production, publishing, website material, media sources and in connection with publicity, all forms of advertising, and promotional materials. I agree to relinquish to Bethel Church all right, title, financial remuneration, and interest in the recordings. I further agree that I, on behalf of myself as well as my heirs, legal representatives, successors or assignees, will hold Bethel Church harmless from any and all liability and will never assert any claim against Bethel Church and/or the aforementioned arising from or out of the media productions, reproduction and/or use of the aforementioned media recordings.

By typing my FULL name in the field below I am confirming
I have read the above and understand and agree to its contents. *

Date * +

Phone Number *

Are you a legal adult? *

I am 18 years old or older

I am under 18 years old; my parent or guardian’s signature is below:

Guardian’s FULL name *

Date * +

Phone Number *

Additional Comments: