- I hereby understand that my personal details provided above are subject to disclosure for legal purposes and I authorize the specific facility to gather all the necessary details for my application to ensure the safety of both parties.
- I acknowledge that some or all of my personal information may be shared with the appropriate authorities if I (1) am a danger to myself or others, (2) disclose current child abuse, (3) disclose that a member of the medical community has assaulted me, or (4) disclose that there is a vulnerable person at risk.
- I agree with my counsellor's cancellation policy that I must inform my counsellor of any absences in advance, or I will be charged for half of my usual fee.