PLEASE READ CAREFULLY
Required Waiver and Release of Liability
must be read and acknowledged at time of initial Crisis Hotline Correspondence.
You as the user agree that using any or every part of this service is entirely at your own
risk. Pastoral Counseling Services are provided "as is", without warranty of any kind, either express or implied, including
without limitation any warranty for information services, counseling, uninterrupted access, or products and services provided
through or in connection with the service. This service is requested at the user’s own choice and with inherent singular
responsibility.
The user agrees that the use of all, or part, of the service is entirely at the user’s own risk. Any actions or lack
of actions, taken by the recipient of such advice is done so solely by choice and responsibility of the recipient and is neither
the responsibility nor liability of the Pastor.
This service is not meant to
be a substitute for counseling or treatment for suicidal ideation, or severe psychiatric problems. This service is an excellent
way to gather individualized information by which decisions can be made. When asking for Biblical based counseling assistance,
advice, or coaching on a personal problem, it’s important the user understand the limitations of discussions when
using this service. Because of the nature of this type of counseling, the user may not provide all information to us. This
prevents us from providing the user with maximum effectiveness.
No assumption of responsibility is made, or given, and the party requesting such advice agrees not to
hold the pastor responsible or liable in any form or fashion, for such actions taken of their own accord. The method and process
by which this advice and direction are given in no way would constitute an agreement or liability on the part of the provider
and is acknowledged to be different in many ways than a one-on-one clinical or psychological counseling process.
Confidentiality
We are very sensitive to the issue
of confidentiality. Confidentiality is crucial to an effective and trusting counseling relationship. The Bible repeatedly
warns against gossip and indicates that trustworthy persons keep a confidence. To release counseling information without your
consent would violate both commonly accepted codes of counseling ethics and biblical standards.
There are three situations, however,
where it may be necessary for us to share certain information with others.
By signing this agreement you authorize the counselor
to share information with others in the following circumstances:
1. When there is clear indication that someone may be
harmed.
Adult and Domestic Abuse: If we have reasonable cause to
believe that an adult is in need of protective services (regarding abuse, neglect, exploitation or abandonment), we may report
such to the local agency which provides protective services
2. Serious threat to Health or Safety: If you express a serious threat, or intent to kill or seriously injure
an identified or readily identifiable person or group of people, and we determine that you are likely to carry out the threat.
We must take reasonable measures to prevent harm. Reasonable measures may include directly advising the potential victim of
the threat or intent.
3. When a child is being sexually or physically victimized
Child Abuse: If we have reasonable cause, on the basis of my
professional judgment, to suspect abuse of children with whom I come into contact in my professional capacity, we are required
by law to report this to the DHS.
I understand and agree with the following statements:
1. Pastor Teddy Awad, counselor, is neither psychological nor a medical professionals.
It is a policy for us to not charge for the counseling time and after-hour crisis calls. Many at times we have received donations
from clients for the Ministry work to help others that are less fortunate. This
Counseling Ministry is strictly a voluntary counseling ministry only. Please think of those who are less fortunate and are
not covered by insurance who take advantage of our services. The greatest gift you could give us is your prayers and support.
2. The stated Confidentiality agreement will be maintained that has
been submitted to you in writing. Biblical Ethic’s will be practiced and honored.
3. Your initial counseling session will be for evaluation purposes giving
opportunity for you and for the counselor(s) to evaluate whether or not continued counseling will be the best course of action
to meet your needs and achieve the goals of spiritual growth and healing.
4. Counseling offered by Pastor Teddy Awad is based upon biblical perspectives
derived from the Holy Bible and how to apply the Word of God to your daily life in a practical, as well as spiritual, manner.
The goal of all the counseling will be to create new paths of rational thinking.
5. The goal of this counseling ministry is not to create a dependency
upon Christian counseling, but to help you grow spiritually and become free through the power of the Blood of Jesus Christ
and to have life more abundantly according John 10:10.
Pastoral Counseling or Coaching Disclaimer
When asking for Biblical based counseling assistance, advice, or coaching on a
personal problem, and because of the nature of this type of counseling, the user may not provide all information to us. This
prevents us from providing the Client with maximum effectiveness. You as the Client agree that using any or every part
of this service is entirely at your own risk. Pastoral Counseling Services and Coaching by Theodore (Teddy) V. Awad, Jr. are
provided "as is", without warranty of any kind, either express or implied, including without limitation any warranty
for information services, counseling, uninterrupted access, or products and services provided through or in connection with
the service. This service is requested at the Client’s own choice and with inherent singular responsibility. The Client agrees that the use of all, or part, of the service is entirely at the user’s own risk. Any actions
or lack of actions, taken by the recipient of such advice is done so solely by choice and responsibility of the recipient
and is neither the responsibility nor liability of the Pastor, Counselor, nor coach. This service is not meant to be a substitute
for Clinical or psychological counseling or treatment for suicidal ideation, or severe psychiatric problems. This service
is an excellent way to gather individualized information by which decisions can be made. No assumption of responsibility
is made, or given, and the party requesting such advice agrees not to hold the pastor, counselor, or the Coach responsible
or liable in any form or fashion, for such actions taken of their own accord. The method and process by which this advice
and direction are given in no way would constitute an agreement or liability.
Required Waiver and Release of Liability
Young
Adult Crisis Hotline and Biblical Counseling Center are affiliated with the TOPEC (Total Personal Care Foundation) an internationally recognized
nonprofit that is registered as a 501(c)3. We are supported wholly by gifts from donors.
RELEASE OF LIABILITY CONTRACT
This RELEASE and Waiver
of LIABILITY is made and entered into on this __________ day of _______________, 20_____, by and between Young Adult Crisis Hotline and Biblical Counseling Center that is affiliated with the TOPEC (Total Personal Care Foundation)
hereinafter designated Theodore (Teddy) Awad, Jr., and _________________________________ hereinafter designated
Client; and, if the Client is a minor, the Client's parent or guardian _________________In return for the use, today and on
all future dates the Client, his heirs, assigns, and legal representatives, hereby expressly agree to the following:
I,
the undersigned, in consideration of the services provided by Theodore (Teddy) V. Awad, Jr., do hereby remise and release from any and all prosecuting legal action as a direct or indirect result of any involvement
I may have either with Young Adult Crisis Hotline and Biblical Counseling Center that are
affiliated with the TOPEC (Total Personal Care Foundation). I further understand that
it is the specific intent and purpose of this legally binding document to release and discharge and all claims and causes
of action of any kind or nature which are directed toward Counselor, Pastor, Coach, or company. This includes causes which
are known or unknown, specifically mentioned or implied, or not mentioned nor implied, which might exist or be claimed to
exist at or prior to the date of this document. The undersigned further specifically waives any claims or right to assert
that any cause of action or claim or demand has been, through oversight or error, intentionally or unintentionally omitted
from this release. The undersigned also understands that Counselor, Pastor, Coach, or company is a personal coach and ordained
pastoral counselor, but is not state licensed. Also when the term counseling or counselor is mentioned above it does not refer
to psychological, state licensed professional, psychiatric, or clinical medical advice. The advice is based on how to think
rationally and clearly from a Christian perspective only. The nature and source of all information given comes from the Bible
and therefore is Biblical counseling or sometimes referred to a Christian Counseling or Coaching.
I HAVE READ AND UNDERSTOOD
ALL OF THE ABOVE.
_____________________________________Date____________________ Initial’s
Witness ___________