I/We affirm the accuracy of the personal information provided herein, have read the information above, and agree to the conditions set forth therein. I hereby agree to the following conditions:
1. I (We) understand that the counseling I (we), my family, or those legally under my guardianship will receive will be based upon the Bible, with the goal of glorifying God and leading to grace-filled, godly living.
2. I (We) will keep the appointment time or will call prior to 24 hours to cancel with a legitimate excuse. In respect of my counselor’s time and preparation, as well as other counselees who could have had this time slot, if I fail to call 24 hours in advance (unless it is an emergency), I will pray about the amount the Lord would have me donate.
3. I (We) will fulfill the weekly assignments or the session might not be held.
4. I (We) will consistently attend a Bible-believing, teaching and practicing church while I am (we are) in counseling, and, preferably, at least one other Bible teaching study/service during the week.
5. I (We) understand that confidentiality is an important part of the counseling process and my counselor is careful to protect the confidentiality, desiring to operate under high ethical principles.
However, there are times when my counselor must share certain information with others, such as
a. Counselors, pastors of your church, or the pastor/elders of IMC must be consulted for advice.
b. Information is revealed which indicates a genuine potential for harm to you or to others. In that case, counselors may have to share that information with the appropriate authorities or family members, being obligated by conscience and by the laws of this state in regards to counseling relationships, being required to report to the appropriate authorities any information that raises suspicion of child abuse, intent to harm oneself, and/or intent to harm another person.
c. A person persistently refuses to renounce a particular sin. In that case, it may become necessary to seek the assistance of others in the church to encourage repentance and reconciliation (Proverbs 15:22; 24:11; Matthew 18:15-20)
I understand my counselor(s) strongly prefer (s) not to disclose personal information to others and desire(s) to help me find ways of resolving problems as privately as possible.
6. Due to the litigious society, this counselor has been asked to have a release signed by each counselee as follows:
I (We) do hereby agree to hold all counselors affiliated with our PASTORAL Counseling Services, and its leadership harmless from any advice, counsel, or suggestions rendered during our counseling sessions. We recognize that their role is to assist me/us in hearing and understanding
God’s will in the matters we discuss. We will not, therefore, sue or engage in any type of litigation negatively affecting this church, nor their Biblical Counseling Services, or organizations granting them the ability and resources to provide counseling services. Furthermore,
I/we agree not to attempt to subpoena or require any counselor to appear in any legal proceeding related to any matters discussed during counseling, nor will I (we) attempt to subpoena any notes or records related to this counseling.
7. I/We will purchase any books or materials for homework assignments that my counselor
8. Unfortunately, PASTORAL COUNSELING SERVICES is unable to provide child care
9. Our Counseling Services is a faith-based ministry that depends upon generous contributions of its counselees, members and partners. Additional costs are underwritten by church members.
COUNSELING & CEREMONY OFFICIANT FEES:
A. 4 Counseling Sessions: $_______
B. Rehearsal (1 hour): $________
C. Ceremony Officiant (3 hours): $______ (plus $2_____ security deposit)
D. If running late a $_______ per hour fee is taken from security deposit for maximum of 2 hours. If on time we issue check refund the same night of ceremony.
F. If the ceremony is outside of our County there will be a need to accommodate the pastor's travel or/both lodging expenses. Please request an estimate by email from our Administrative Team by contacting them here
OFFICIAL BOOKING REQUIREMENTS: Before counseling, rehearsal, or ceremony is booked booking fees should be closed by giving here
Thank you!
10. If you have any questions about payments or booking please contact our Administrative Team here
