🙏 Jesus Testimony Submission & Release Form

Thank you for being willing to share what Jesus has done in your life. Your story may help bring hope, healing, and faith to others.

✨ SECTION 1 — ABOUT YOU

Full Legal Name

Preferred Name for Contact

Email Address

Phone Number

State/Country

Age Confirmation

I confirm I am 18 years or older

I am under 18 years of age and understand that a parent or legal guardian must complete and sign the consent section on my behalf

SECTION 2 — YOUR TESTIMONY

What title would you like to give your testimony?

Type of Story

Healing miracle

Redemption/salvation

Deliverance

Freedom from addiction

Marriage restoration

Financial breakthrough

Protection

Supernatural encounter

Prayer answered

Other

Main Story -Please share your testimony in as much detail as possible.

Before: What was your life or situation like before Jesus moved?

Encounter: How did Jesus work in this situation?

After - What changed afterward?

Message What do you hope someone reading your testimony receives from it?

Scripture Is there a Bible verse connected to your testimony?

🕊️ SECTION 3 — PRIVACY & NAME PREFERENCE

How would you like your name shown?

Use my full real name

Use first name only

Use pen name

Keep anonymous

If pen name - What name would you like used?

Privacy edits

Please change names of other people in my story

Please change city/location

Please remove identifying details

This story includes sensitive family/legal/medication information

No changes needed

Anything private? Are there any details you do NOT want included?

Editing Permission

I give permission for grammar, spelling, and clarity edits while keeping the truth of my testimony intact

I give permission for names, locations, and identifying details to be changed for privacy and legal protection

SECTION 6 — FULL LEGAL RELEASE / SIGNATURE

I confirm that this testimony is a truthful account of my personal experience to the best of my knowledge.

I voluntarily grant permission to Melinda Byers to use, edit, reproduce, publish, distribute, promote, and display my testimony, submitted words, optional photos, audio, video, and related materials in books, e-books, devotionals, audiobooks, church materials, ministry resources, podcasts, websites, social media, promotional materials, video, and future related projects in any format now known or later created.

I understand my testimony may be published using my selected name preference, including real name, first name only, pen name, or anonymously.

I understand reasonable edits may be made for grammar, clarity, length, privacy, and legal protection while preserving the truth and meaning of my testimony.

I release and hold harmless Melinda Byers from claims related to the authorized use of this testimony.

I understand this permission remains in effect unless otherwise revoked in writing before publication

✍️ FINAL SIGNATURE BOX

I have read and agree to the testimony release terms above