Freedom Ministry Application

Name

Date of Birth

Address

Phone

This address will receive a confirmation email

What church do you attend?

Have you read Don Dickerman's book When Pigs Move In?

Yes No

Gender

Male Female

Marital Status

Single Married Separated Divorced Widowed

Do you have children? Yes No

If yes, please give names and ages of children.

Are you saved?

Father's last name & ancestors country of origin:

Mother's last name & ancestors country of origin:

History

It is not necessary to go into detail with any of your responses.

Were any of your ancestors involved in: Freemasonry Eastern Star Rainbow Girls Oddfellows Rebecca Lodge Other

If any of the above are marked, please explain.

From birth and your early childhood, ask the Holy Spirit to show you any area of concern (trauma during pregnancy by Mom or Dad, divorce, words of

Early childhood fears, injuries, nightmares, see things in your room, felt evil presence, etc.

Any sexual abuse or sexual embarrassment as a child? No Yes

Any spoken words from parents or otheres that were received as condemnation and/or embarassaing or humiliating experiences at school or from a school teacher?

Any physical abuse from parents or others?

Please explain anything that is checked above. (your age when parents divorced, what unusual fears, when you were exposed to pornography, example of feeling rejected, etc.)

Please list any accidents or injuries that come to your mind as being frightening to you at the time.

Please list any surgeries and your approximate age at the time.

The purpose of this form is to help determine possible entryways for evil spirits... Obviously, generational/ancestral permission, as forewarned in Exodus 20:5, is a possibility in anyone's life. There are 30 ancestors in your history that could have passed a spirit on to you. Likely, you only know about your parents and each of their two parents.

Please give any information that the Holy Spirit brings to your mind. And please identify which side of the family.

Do you have any objects in our home or possessions that relate to ungodliness or cults. This would include new age religions, such as books about eastern deities, crystals, heavy metal music, Native American artifacts, wiccan, etc. Yes No

If yes, please explain.

Do you have nightmares? Yes No

Do you hear voices? Yes No

If yes, please explain.

Please list any medical diagnosis given by a doctor.

Do you have inexplicable pain with no medical explanation for it? Yes No

If yes, please explain.

Do you have difficulty trusting others? Yes No Option

If yes, do you know why?

Have you experienced the death of someone close to you? Yes No

If yes, who?

Do you feel you have any eating disorders? Yes No

What is your approximate weight and height?

Any sleep disorders?

Family medical history. (diabetes, heart disease, cancer, asthma, etc.)

Did you have imaginary friends as a child? If so, please explain.

When attending church or other ministries, do you have Yes No

If yes, please explain.

Do you have difficulty retaining God's Word? Yes No

Have migraine headaches? Yes No Option

Struggle(d) with addictions? Yes No

Were you ever diagnosed with a learning disability i.e. (ADD/ADHD), etc?

Have a fear of death? Yes No

Have had suicidal thoughts. Yes No

Has there been a time in your life that you've been angry with God?

Have you had a fear of losing your mind?

Anxiety or panic attacks? Yes No

If yes, when did they begin?

Feel incredible loneliness? Yes No

Plagued with doubt/unbelief? Yes No

Do you feel inferior? Yes No

Have thoughts of inadequacy? Yes No

Have obsessive thoughts? Yes No

Blasphemous thoughts? Yes No

Compulsive thoughts? Yes No

Sexual dreams? Yes No

Lustful thoughts? Yes No

Daydream? Yes No

Diagnosed with depressions? Yes No

Feel the need to be in control. Yes No

Rebellious? Yes No

On an insecurity scale of 1 - 10, with 10 being the worst, which applies to you?

Female

Check all that apply to you: Pre-menopausal In menopause Post-menopausal PMS difficulties Use or have used birth control pills Diet or weight control pills Hormone Replacement pills

Below are a few very common symptoms for those under demonic attack. (It doesn't necessarily indicate demonic oppression.)

Certain physical symptoms which may appear suddenly or leave quickly, and there are no physical or physiological reason. Choking sensations Pains which seem to move around, for which there is no medical cause. Feelings of tightness about the head or eyes. Dizziness, blackouts, fainting or seizures.

Any additional comments:

Before submitting this form:

In order for this ministry to be successful, there can be NO unforgiveness in your life. Unforgiveness is legal permission for demons to torment believers. (Matthew 18:23-25) Do not neglect the area of forgiveness for yourself. You must also forgive yourself in order to be free. A typical prayer might be as follows:
"Father, because You have forgiven me, I choose to forgive others, everyone who has hurt me, lied to me or disappointed me, I forgive. I confess unforgiveness as a sin and repent of it. I receive Your forgiveness and apply it to my life by forgiving myself. Thank You for Your grace and mercy in Jesus' name. Amen."

If there was ever any involvement (however innocent) in Satanic activities, witchcraft, cults or occultic activities, they must be renounced. Typical prayer:
"Father, I renounce any bond or agreement I ever made with Satan and the kingdom of darkness. I know there can be no valid contract with a liar and I renounce any words, oaths or pledges made to Satan and I choose to be totally free from the. I choose to be cleansed from any ties with Satan in Jesus' name. Amen."

Sexual relationships outside of marriage... are called "Soul Ties" and each one could be an entry point for demon spirits. The ties must be broken by confessing them as sin and choosing to be free from them. Below is a prayer you can pray. It would be best if you could do so by denouncing each one by name, do the best you can with that. The deliverance process involves canceling permission of evil spirits to be in our life. This prayer and renunciation will cancel consent that was granted through soul ties. The prayer can be something like this: "Father, I confess the sin of sexual relations outside of marriage. I renounce that sinful activity in Jesus' name. I call back that part of me that was given to another, and I refuse that part of another that may have come to me. I denounce soul ties with and choose to be free in Jesus Christ's name. Amen."

False religions must also be confess and renounced:
"Father, because of my relationship to You through Your Son Jesus Christ, and in His Name I renounce all associations with pagan worhsip, false gods, false deities, and any involvement with them. I forgive my ancestors for thier involvement and break any ties to any religion that denies the deity of the Lord Jesus. He alone is Lord. H alone can forgive sin and give man eternal life. I fully trust Jesus Christ and I separate myself from the sins of my ancestors in Jesus Christ's name. Amen."

I have dealt with the above issues and prayed the above prayers.

Yes No

Freedom Ministry Application

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