Prayer / Testimony Submission Form
V-Kol Media / Praying For YOU / TheCRY / Faytene TV
Address Line 2
Prov or State
Newfoundland and Labrador
Prince Edward Island
Postal Code / Zip Code
Purpose of Contact
Please indicate the
reason why you are contacting us:
I would like prayer.
I would like to share a testimony.
I would like to give my life to Jesus.
I would like to be connected to a church.
Please indicate your communications preferences.
I would like someone to contact me to pray for me in real time if possible.
I would like someone to contact me to share how I can give my life to Christ.
I do not want a contact, please simply pray for my request. Thank you.
I do not want a contact, I just want to share my testimony to encourage you.
I do not want contact.
If applicable, please share more. What is your prayer request or what is your testimony?
If you shared a testimony, do you give us permission to share this testimony with our supporters and viewers?
Yes, but please keep my name anonymous.
Would you like someone from a nearby church to contact you so that you can connect with people of faith, and a fellowship we know of, in your own community?
No thank you.
How did you hear about this?
Praying for You on TV
A Direct Communication from V-Kol
I acknowledge that I am contacting you of my own free choice. I also recognize that this is a free service offered in Christian love by V-Kol Media Ministries.
I release V-Kol Media Ministries from demand or liability related to interactions that I may have with any volunteer or team member that may contact me in response to this form.
I recognize that V-Kol Media Ministries does not offer professional counselling services, medical advice or psychiatric advice and that any action taken as a result of my interactions with a volunteer or staff person is my own personal choice.
V-Kol Media Ministries shall not be held liable for any action I may take as a result of this or any other related communication with a volunteer or staff member representing the ministry.
I do not agree.
If you checked "I do not agree" our team will
be in contact with you, even if you requested it in prior preferences. Thank you for understanding.
V-Kol Media Ministries