Informed consent

192 views

Published on

Informed Consent Form

Published in: Spiritual, Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
192
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
7
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Informed consent

  1. 1. INFORMATION DISTRIBUTION Informed ConsentHope Aglow Empowerment Center is blessed to have a dedicated team of prayer warriorswho intercede on behalf of the members for all needs. These intercessors are trained notto discuss the contents of the prayer requests with those with no valid need to knowbecause of our concern to safeguard your privacy. Members of the church undergo aseries of challenges ranging from illness, hospitalization, death of a loved one, job lossesand other pressing issues. We want to stand in the gap with you for Gods divineintervention to bring about a breakthrough regarding your specific situation. However,we want to ensure that we have your permission before we can pass your prayer requestto the prayer team or the church leadership.Please indicate your preference in terms of disclosure by checking one of the choicesbelow: (please check ONLY ONE):________________ Please provide my information to the key leadership and prayer teamfor contact and prayer. This would include my name, number and email. I am also OKwith a short brief description of the event they are calling about.________________ Please DO NOT provide my information to the key leadership or theprayer team. Specifically, do not provide my number or email contact. However, a shortbrief description for the purpose of prayer can be sent.________________ Please only supply my name and a short brief description of theevent. I would NOT like any contact from key leadership or the prayer team.________________ Please DO NOT distribute my information to anyone outside of thePastoral Care Division who is responsible for contacting all members on behalf of PastorStevens. I fully understand any information received by this division will be shared withthe Senior Pastor.By signing this consent form, you are agreeing to your preference for communication inthe case of prayer. If you so happen to change your mind, please contact the front office703-490-4673 members@hopeaglow.org to complete a new form or rescind yourpermission altogether. Thanks._______________________ __________________________Print name Sign name ___________________________________ Date

×