• Form

  • The Park Ministries Counseling Intake Form

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  • Children - Names & Ages:

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  • WAIVER OF LIABILITY:

    THE PARK CHURCH CANNOT BE HELD LIABLE FOR ANY PERCEIVED DAMAGES INCURRED DURING COUNSELING SESSIONS.
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  • Counseling Ministry Purpose Statement: To assist in developing Kingdom citizens by providing Christian counseling and activities which aids counselees in understanding who they are in Christ and applying their faith to life situations so that they may better worship and serve God.

  • COVENANT OF CONFIDENTIALITY

  • Counseling sessions are to be kept confidential and should not be disclosed to anyone except in the following circumstances:

    1. The counselee appears to be a threat to harm him/herself, any other person, property or there are any reports of abuse to a minor, the elderly, or the handicapped.  Such instances must, by law be reported.
    2. Supervised sessions with persons within the counseling Ministry or in a class setting for Lay Counselors for instructional purposes.
    3. Counseling procedures and progress may be discussed with the minor's parent or guardian for counselees who are minors.
    4. When subpoenaed by the court to submit case notes for trial purposes.  (Counselors are legally bound to submit the requested chart materials.)   

    I agree to adhere to the confidentiality covenant as stated above.

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