Pesonal Data Inventory – Release of Libility

 I do hereby willingly and without reservation seek out religious, Biblical based counseling on my own accord. I understand my participation, and the participation of those in my custodial care within the religious counseling ministry, Donaldson Christian Counseling, Inc., (hereafter DCC), is on a strictly voluntary basis.

I accept full responsibility for my participation and I agree to defend and hold harmless any and all representatives of DCC, as it relates to the services received, directly or indirectly, through the counseling, support groups, or other ministerial activities related to the ministry of DCC.

I understand and agree that all files and any form of communications including but not limited to; emails, texts, session notes, and all other social media, written, and electronic information related to my participation, or the participation of those under my guardianship, within the pastoral counseling ministry of DCC are held confidential within the Priest-Penitent communications privilege and are the exclusive property of DCC with all rights reserved.

I affirm that all counseling records, as noted above, are the sole and exclusive property of DCC and will not be released under any circumstances.

As a result, I agree to assume any and all legal, personal, and circumstantial liability and responsibility associated with my participation and the participation of those in my custodial care, relating to the services provided by any religious counselor(s), agent(s), or representative(s) of DCC.

I also agree to personally hold harmless and release any counselor(s), agent(s), or representative(s) of DCC and their families from any and all liability associated with my participation, and the participation of any persons under my custodial care, as it directly or indirectly relates to any and all services received, performed, treatment(s) suggested, or counseling guidance provided, by DCC representatives, either independently or jointly.

I affirm that my participation is without duress or forcible influences and that my personal intention is to seek out Christian counseling ministerial services for myself and those within my custodial care.

I understand DCC is a religious counseling center and I willingly declare that no counselor(s), agent(s), or representative(s) has at any time or in any manner represented DCC in any way as a psychological or psychiatric mental health facility and has in no way claimed any form of State, Federal, or Association affiliations to mental health licensing or certification.

I further understand and agree that the ministry services provided by DCC are in the strict context of a Biblical counseling, Christ centered ministry, and the treatment plan suggested by DCC representatives will not necessarily agree with those services provided by a psychological or psychiatric mental health care facility.

By clicking the “I Agree” button below, I affirm I have read, fully understand, and accept the release of liability statement outlined above for myself and those in my custodial care.  I also affirm that I have listed all information requested to the fullest extent possible and to the best of my knowledge all personal data is complete and accurate.

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