Statement of Informed Consent (Please Read Carefully before confirming)
Limited Confidentiality
The care volunteer you will speak to will make every effort to guard the information shared in strict confidence. However, if you are speaking to a care volunteer, they may be required to respond to legal proceedings about information shared. In addition, the following information will be reported to the appropriate governmental authorities and/or other affected persons or entities:
Disclosure of child abuse
A disclosure of elder or dependent adult abuse
A disclosure of spousal abuse
A disclosure that you present a serious risk of harm to yourself
A disclosure that you present a serious risk of harm to another person
A disclosure which in the opinion of the spiritual care volunteer requires action to protect another congregant or; the church itself; or any other interest of the church.
Waiver of Liability
I am acknowledging that having sought spiritual care as such is adhered to by Bedrock Church Lynchburg, a nonprofit religious organization, I hereby acknowledge their understanding of the noted conditions and further release from any and all liability, without recourse, Bedrock Church Lynchburg, its agents or employees, from any claim arising from the undersigned's participation in the abovementioned spiritual care program. The same being identified as follows:
1. It is understood by the participant that all spiritual care activities will be provided by volunteer peers, not licensed therapists or professionals of any designation.
2. That all spiritual care provided in the Care & Recovery Ministry is provided in accordance with the Biblical principles as adhered to by Bedrock Church Lynchburg, and are not necessarily provided in adherence with any local or national psychological or psychiatric association.
3. That no representation has been made, either expressly or implied, that spiritual care, as conducted by the abovementioned spiritual care volunteers, is accepted as customary psychological and/or psychiatric therapy within the definitional terms utilized by those professions.
Submitting this form indicates that I have read this Waiver of Liability and agree to the conditions of the Care & Recovery Spiritual Care Ministry. I also declare that all the information I provided in this document is true.
By clicking "Yes," you are indicating your acceptance of the conditions above
Statement of Informed Consent (Please Read Carefully before confirming)
Limited Confidentiality
The care volunteer you will speak to will make every effort to guard the information shared in strict confidence. However, if you are speaking to a care volunteer, they may be required to respond to legal proceedings about information shared. In addition, the following information will be reported to the appropriate governmental authorities and/or other affected persons or entities:
Disclosure of child abuse
A disclosure of elder or dependent adult abuse
A disclosure of spousal abuse
A disclosure that you present a serious risk of harm to yourself
A disclosure that you present a serious risk of harm to another person
A disclosure which in the opinion of the spiritual care volunteer requires action to protect another congregant or; the church itself; or any other interest of the church.
Waiver of Liability
I am acknowledging that having sought spiritual care as such is adhered to by Mariners Church, a nonprofit religious organization, I hereby acknowledge their understanding of the noted conditions and further release from any and all liability, without recourse, Mariners Church, its agents or employees, from any claim arising from the undersigned's participation in the abovementioned spiritual care program. The same being identified as follows:
1. It is understood by the participant that all spiritual care activities will be provided by volunteer peers, not licensed therapists or professionals of any designation.
2. That all spiritual care provided in the Care & Recovery Ministry is provided in accordance with the Biblical principles as adhered to by Mariners Church, and are not necessarily provided in adherence with any local or national psychological or psychiatric association.
3. That no representation has been made, either expressly or implied, that spiritual care, as conducted by the abovementioned spiritual care volunteers, is accepted as customary psychological and/or psychiatric therapy within the definitional terms utilized by those professions.
Submitting this form indicates that I have read this Waiver of Liability and agree to the conditions of the Care & Recovery Spiritual Care Ministry. I also declare that all the information I provided in this document is true.
By clicking "Yes," you are indicating your acceptance of the conditions above
