Pastoral Support Form

Please complete this form to request an initial Pastoral Support appointment with our team. Additional information on how to proceed will be emailed to you after your form is received, including a link to schedule an appointment time. Please make sure to check your spam folder for our reply. All sessions are one hour, and are offered on the Beach Chapel campus. Please make every effort to keep your appointment; should you need to reschedule email us at pastoralsupport@beachchapel.org as soon as possible.

Scheduling Appointments: A follow up email will be sent to you with a link to schedule an appointment. A $35 donation is recommended for sessions to sow into this developing ministry and it's needs. A donation link will be provided in the follow up email.

*Please note: if you are less than 18 years of age, please contact info@beachchapel.org directly instead of completing this form.

Your Name*

First NameLast Name

Email Address*

Phone Number*

Area CodePhone Number

Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Gender*

MaleFemale

Age (must be 18 years or older)*

Briefly describe why you are seeking help*

When did you notice this problem began?*

What solutions have you tried?*

Are you currently under the care of a psychiatrist, psychologist, therapist, or licensed counselor?*

Have you been through any inner healing or deliverance ministry?

YesNo

If yes: when, with whom, and what was the context of your last session?

Check any of the following that apply to you:*

How did you hear about Beach Chapel?*

What is your relationship to Beach Chapel?*

I am an active member of Beach ChapelI currently attend Beach Chapel regularlyI am otherwise associated with Beach ChapelI am not associated with Beach ChapelOther

If you responded "Other", please explain

Liability Release Form

The purpose of this ministry is for spiritual growth and healing. It is not a psychological counseling service, nor is it intended to be. Team members are not licensed psychologists or psychiatrists; however, they are trained in using the Word of God and prayer through the power of the Holy Spirit. The results of this approach depend on the willingness of the individual to make wise choices consistent with the teachings of Jesus Christ. Recommendations for further counseling with a Beach Chapel pastor or outside therapists/practioners may be made after initial appointments if deemed appropriate.

All personal information gathered in the course of a ministry session is confidential, and the files are so maintained; however, information, as needed, may be shared with leaders of Beach Chapel to further my healing process. Beach Chapel prayer ministers may consult with other Beach Chapel team members without the use of individuals' names. Discipleship, the commitment to train others in the mastery of ministry skills, is an ongoing aspect of this ministry. Qualified disciples may be assigned during ministry sessions. The adherence to a strict policy of confidentiality includes disciples working with prayer ministers.

Beach Chapel will abide by all laws regarding the reporting of threats to self, threats to others, abuse of a child, abuse of the elderly and/or other behavior deemed by Beach Chapel to be harmful to yourself or others. Regardless of local laws, and out of care and respect for God's creation, Beach Chapel will report any of the above to the proper authorities.

Beach Chapel will leverage technology including, but not limited to, Zoom and other video conferencing platforms. Beach Chapel is neither responsible nor liable for the use of this technology or any issues related to the privacy and security of such technology. None of the participants will record any session unless all participants agree to the same.

I understand the above information concerning this ministry. I have sought this ministry of my own free will and am under no obligation to accept or reject any of the advice or help that I might receive from the team members of this ministry. All personal information I reveal is given voluntarily in order to facilitate the team members working with me. I further release the Pacific Southwest District of the Wesleyan Church and Beach Chapel from any and all liability, loss, or damage of any kind that may arise or result from these ministry sessions.

Please populate the fields below to acknowledge that you have read the Liability Release Form and that you acknowledge and accept the guidelines stated above.

By writing your name you agree to the Liability Release.

First NameLast Name