Freedom Ministry- Intake Form

I understand that I am participating in this Session or any Church Tsidkenu affiliated meeting or event at my own risk. Church Tsidkenu or its affiliates are not responsible for any injuries or complications that may occur. Church Tsidkenu and anyone associated with them or their events/counseling are not a medical doctor, attorney, psychiatrist, therapist or other licensed health professional. We do not diagnose, cure, heal, or treat disease, or give psychological treatment. We recommend that all participants continue to see their regular medical doctors and trained professional counselors and follow their advice as needed. As consideration for being permitted by Church Tsidkenu and Fire Academy, in the State of California, the County of San Diego to participate in these activities and use the Church’s premises and facilities and staff, I forever release Church Tsidkenu and Fire Academy, the State, the County,, any church affiliated organization, and their respective directors, teachers, pastors, officers, employees, volunteers, agents, contractors, and representatives (collectively “Releases”) from any and all actions, claims, or demands that I, my assignees, heirs, distributees, guardians, next of kin, spouse and legal representatives now have, or may have in the future, for injury, death, or property damage, related to (i) participation in these activities, (ii) the negligence or other acts, whether directly connected to these activities or not, and however caused, by any Releasee, or (iii) the condition of the premises where these activities occur, whether or not I am then participating in the activities. I also agree that I, my assignees, heirs, distributees, guardians, next of kin, spouse and legal representatives will not make a claim against, sue, or attach the property of any Releasee in connection with any of the matters covered by the foregoing release. I HAVE CAREFULLY READ THIS AGREEMENT AND FULLY UNDERSTAND ITS CONTENTS. I AM AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN MYSELF AND THE CHURCH, THE STATE, AND THE COUNTY AND SIGN IT OF MY OWN FREE WILL. Absolute Confidentiality: The communications between leaders and atendees will be considered absolutely confidential EXCEPT to the extent disclosure is required by law or in other instances in which the leader learns of potential threats of harm to self or others, including but not limited to cases of child abuse or neglect, suicide, domestic violence or other violence or physical threats, or homicide. In such instances, information may be disclosed to the TK Pastoral staff or Director of the Tsidkenu Freedom Ministry and/or to appropriate state law enforcement authorities. By signing this document, you agree to such disclosure for supervision purposes only.