I/We affirm the accuracy of the personal information provided herein, have read the information and agree to the conditions set forth. I/We hereby agree to the following conditions:

1. I/We understand that the counselors at Emmanuel are not licensed therapists, psychologists or mental health professionals and as such their counseling is strictly spiritual in nature.
2. If you have significant medical, financial, legal or technical questions you should seek out professional guidance in those areas.
3. I/We agree to hold the Counselor harmless from any advice, counsel or suggestions rendered during our counseling sessions. I recognize that their role is to assist me/us in hearing and understanding God’s will in the matters discussed. I/We will not, therefore, sue or engage in any type of litigation negatively affecting them.
4. Although confidentiality is often one aspect of the counseling process and we intend to guard the information you entrust to us with loving discretion, absolute confidentiality is not scriptural in all circumstances. There are situations when it may be necessary for us to share information with others:
• A. When we are uncertain how to address a particular problem and need to seek advice from another pastor, counselor, professional, or Christian.
• B. When we have reason to believe that someone may be harmed unless others intervene or are consulted.
• C. When required by state or federal laws to report unlawful actions to authorities.
5. I/We understand that Emmanuel may have lay people training, and therefore, agree to have a trainee(s) in the counseling session with me (us).

Having clearly stated the principles and policies of our counseling ministry, we welcome the opportunity to minister to you in the name of Christ and to be used by Him as He helps you to grow in spiritual maturity and prepares you for usefulness in His body. If you have questions about these guidelines, please talk with your counselor. If these guidelines are acceptable to you, please sign and date below.