Care & Counsel Application

Upon completing this application and waiver, please review and submit (sign) with full understanding.
Important Information

Overview

The Care & Counsel Ministry at Resting Place is dedicated to helping you navigate difficult seasons and limiting mindsets through prayer, conversation, compassion, and validation. Our goal is for you to gain peace and freedom through biblical truth and emotional, mental, and spiritual wellness.

Upon receiving your application, the Care & Counsel Team will review your information and follow up with details for setting up a prayer session. A ministry session is typically one hour.
The Care & Counsel Team members are not licensed clinical psychologists, psychiatrists or counselors. Upon completing this application and waiver, please review and submit (sign) with full understanding.
Personal Information

 
 
 
 
 
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Session Information

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Additional Information

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Waiver of Liability

I understand and agree to waive any and all claims of liability against the Care & Counsel Team, as well as Resting Place House of Prayer, that may arise from, result out of, or be related to conduct or counsel provided. I accept that the Care & Counsel Team may recommend further ministry for me from a pastor, counselor, support group and/or agency in my community. 

The Care & Counsel Team in no way guarantees I will receive healing in a particular way or timeframe. The Care & Counsel team members are not licensed clinical psychologists, psychiatrists or counselors. It is agreed that I always have the privilege of termination at any time for any reason.

Waiver of Confidentiality

I accept that my Care & Counsel Team minister(s) may consult with the Care & Counsel Team leadership overall, and/or Resting Place leadership, concerning ministry to me, if further guidance and support is necessary. Personal details and statements shared during a session(s) will be kept confidential and private. It is agreed that any notes and/or files (if any) are the property of the Care & Counsel Team and cannot be released without written consent.

However, I waive my right to confidentiality in the following situations: 

Self Harm/Suicide
I accept and acknowledge that, if the Care & Counsel Team determines that there is a probability of imminent physical harm to myself or others by me, or if there is a probability of immediate mental or emotional harm to me, the Care & Counsel Team may contact and disclose relevant confidential information to medical or law enforcement personnel for my safety and protection.

Abuse of Children and Vulnerable Adults
I accept and acknowledge that the Care & Counsel Team is also required to report any reasonable suspicion of physical/sexual abuse that has been done, or that is being done, to a minor child. If I disclose, or it is suspected, that there is abuse, harmful neglect or exploitation of children or vulnerable adults (i.e. the elderly or disabled), the Care and Counsel team must report this information to the appropriate agency and/or legal authorities.

Prenatal Exposure to Controlled Substances
The Care & Counsel team must report any admitted prenatal exposure to controlled substances that could be harmful to the mother or the child.

I accept that the Care & Counsel Team reserves the right to make such reports, as mandated by law, whether or not they confer with me first. 

By my signature, I acknowledge that I have read and understand all of the above provisions, including the Waiver of Liability and Waiver of Confidentiality, and that I accept the stated conditions and limits of liability and confidentiality.

 
 
“Praise be to the God and Father of our Lord Jesus Christ, the Father of compassion and the God of all comfort,  who comforts us in all our troubles, so that we can comfort those in any trouble with the comfort we ourselves receive from God.” (II Cor. 1:3-4)

Description

Upon completing this application and waiver, please review and submit (sign) with full understanding.