Authorization for Prayer Partner Program

Authorization for Prayer Partner Program
The Prayer Partner Program is a resource for families who are currently engaged in Chosen's Services. This will allow the Chosen Client to receive support from an approved Prayer Partner. The approved Prayer Partner will be given only the name and address of the Chosen Client so the Prayer Partner can support the Chosen Client through prayer and occasional encouragement through mail. The Prayer Partner Program is not supervised by any Chosen Staff. By signing this form, I understand that Chosen is not liable for any interactions or communication with the assigned Prayer Partner.
I, First Name Last Name understand that the Prayer Partner Program is not supervised by any Chosen Staff and Chosen is not liable for any interactions or communication with the Prayer Partner.
This authorization is effective for a period of one (1) year from the signature date or
as otherwise specified: Date
After the effective date, this Authorization to use or disclose information listed above expires. I understand that I have the right to revoke this Authorization, in writing, at any time by sending such written notification to Chosen, located at 144 Clemens Ave New Braunfels, Texas 78130. This authorization has been read to me/or by me and I understand its meaning.
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