Name *

First Name

Last Name

Phone *

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How many conversations are you looking for? *

All JF conversations are virtual and 30 minutes each to fit into your schedule. A link to Bryan's calendar will be sent once this form is completed. The first conversation is FREE. We ask for a minimum $20 donation for each conversation after that.

Starting Line - 1 Conversation

Boost - 2 Conversations

Accelerate - 4 Conversations

Fuel - 6 Conversations

By checking this box I certify I am at least 18 years of age or older. *

I'm at least 18

Participation Agreement *

I hereby acknowledge that I voluntarily agree to attend and/ or participate in Jesus Fit conversations with Bryan Willkom. I understand and agree that Bryan Willkom is not acting as a mental health counselor or a medical professional in any capacity.

I Accept

Confidentiality Agreement *

I understand that Bryan Willkom will protect my information as confidential unless I state otherwise in writing. I understand and agree that the use of technology is not always secure and I accept the risks of confidentiality in the use of email, text, phone, Zoom and other online platforms.

I Accept

Liability & Release Waiver *

I hereby release, waive, acquit and forever discharge Bryan Willkom and Jesus Fit, any agents, successors, assigns, personal representatives, executors, heirs and employees from every claim, suit action, demand or right to compensation for damages I may claim to have or that I may have arising out of acts or omissions by myself or Jesus Fit. I declare that no promise, inducement or agreement not expressed in this agreement has been made to me to sign this agreement. I have the legal ability to give my informed consent, and hereby give such consent to Bryan Willkom to assist me towards achieving my spiritual goals. I understand and agree that by filling out my contact information below and submitting this form, that I have reviewed, understand and agree to these statements and terms and conditions stated above.

I Accept