Name *

First Name

Last Name

Phone

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Type of Fast: (Check all that apply)

My Fasting Plan

Full Fast (e.g., water or liquids only)

Partial Fast (e.g., skipping meals, fasting specific foods like a Daniel Fast)

Non-Food Fast (e.g., social media, entertainment, or other distractions)

Other

Duration of My Fast: (Check one)

I will fast for all 21 days.

I will fast for a portion of the 21 days: __ days.

Days and Times I Will Be Fasting and Praying: (Check all that apply)

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

My Prayer Commitment I commit to seeking God through prayer during the 21 Days of Prayer and Fasting by:

Participating in daily personal prayer and devotion.

Attending Tuesday Night All-Church Prayer Gatherings.

Participating in the Tuesday Noon Prayer Pause.

Joining the 9:15–9:45 AM Prayer Time (Sundays, led by men and open to all).

Other (e.g., praying with my family or small group)