Agape First Ministries
Agreement for Participation in Non-Professional Christian Counseling
I understand this Agreement is a legally binding document controlling the terms and conditions of my participation in Agape First Ministries (AFM) counseling ministry. I understand that AFM counseling ministry is non-psychotherapeutic, non-licensed, non-professional Christian counseling based on the Christian Bible and AFM Statement of Faith, offered by fellow brothers and sisters in Christ (“Christian Counseling”). My participation in the Christian Counseling is entirely voluntary, and I understand it is not a substitute for psychiatric, psychological, or other professional therapeutic services. I accept complete responsibility for my own psychological, emotional, and spiritual well-being, and I agree that I am solely responsible to ascertain my need for professional services and to obtain such services as needed. To the extent any AFM staff, intern or volunteer holds a license or certificate in a professional field, including without limitation, psychology, psychiatry, counseling, medicine, or law, I understand they are not acting in their professional capacity while participating in this Christian Counseling, and I will not attempt to hold them to any standards required by their licensure or certification. I understand that AFM makes no guarantee that it will “fix” me or free me of unwanted symptoms, and I understand that all EXPRESS AND IMPLIED WARRANTIES ARE SPECIFICALLY DENIED.
AFM values privacy and will endeavor to carefully guard my confidential information. I understand, however, that there are circumstances such as those listed below which may necessitate AFM sharing my confidential information:
- To consult with colleagues and supervisors, who will also endeavor to keep my private information confidential, to collaborate on how to best serve me, or for supervision and training of Christian counselors;
- To prevent me from breaking the law, or harming myself or another person;
- To protect me from harm by another;
- To comply with a legal duty to report or other legal order; or
- To seek legal or other professional advice.
For participants who are minors, AFM will also report suspected abuse and neglect to the proper authorities. AFM may also share confidential information with authorities and the minors’ parents or guardians if, during the minor’s participation in the Christian Counseling, the minor breaks the law, has sexual contact with another, or engages in any other activity that AFM believes, in its sole discretion, is harmful to the minor’s well-being. Minors will participate in small groups and/or accountability groups which are exclusively for minors and will be closely supervised.
I understand that AFM Christian Counseling offers hope for those struggling with sexual and relational brokenness; including those struggling with sexual attraction to minors. AFM will take appropriate measures to protect the safety of all participants.
To cover basic costs of its Christian Counseling program, AFM charges a standardized fee for each approximately 50-minute individualized counseling session. Fees for group sessions are negotiated. Financial aid or an op on to work off fees may be available to qualified applicants.
In additional consideration for my, or my minor child’s, participation in the Christian Counseling, I agree, on behalf of myself and my minor child if he or she is participating in the Christian Counseling, and my and my child’s heirs, executors, guardians and other legal representatives, to release AFM, including its officers, directors, employees, volunteers and other agents and those of any successor or affiliate of AFM, from all liability for injuries, damages or losses arising out of my or my child’s participation in the Christian Counseling, and I agree to hold the same harmless from any claim of liability asserted against any of them by me or on my behalf, or by my minor child or on his or her behalf.*
By signing this Agreement, I affirm that I have thoroughly read and understood it, and unreservedly accept its terms. This Agreement will remain in effect as long as I or my minor child participates in the Christian Counseling, and the waiver and release of liability terms shall survive the termination of this Agreement.
By providing information below you are giving your electronic signature to this agreement.
*Parent/Guardian signatures are only required if participant is under 18 years of age, in which case both parents/guardians’ signatures are required.