Lay Counseling Agreement

Lay Counseling Agreement
The following is a standard agreement for everyone seeking counsel from Christ Community Church (CCC) through the lay counseling ministry. If you have any questions about this agreement, please ask the counseling ministry staff. The men and women who provide biblical counsel seek to serve people according to the truth and grace of God’s Word. They have been trained under the biblical counseling ministry of Christ Community Church and are overseen by CCC leaders/pastoral staff. Typically, they do not hold a degree of higher education in counseling and do not hold a license in the State of North Carolina. They all have earned a Certificate of Completion in the lay counseling training program.

All lay counselors assigned to help you will attempt to protect all matters of confidentiality during counseling sessions. There are limits however, to this confidentiality that may require your counselor to seek additional assistance for you or your family. These circumstances include:
1) You made reference to harm yourself or someone else
2) You discussed ANY type of abuse toward a child or elderly adult known to you
3) Your lay counselor believes it necessary to involve others, such as an overseeing pastor, fellow counselors, or counseling professionals for supervision and referral purposes.

It is my understanding that I am entering into a process of lay counseling where personal and difficult issues may be discussed. While those with whom I counsel are expected to be respectful of my personal beliefs and opinions, I acknowledge they will counsel me according to the Bible. There is no fee associated with lay counseling sessions. If I believe it necessary for my minor children to participate during sessions, then this agreement serves as written permission for the lay counselor to meet and counsel with me and my children. If during the process of counseling I become uncomfortable with the process or unwilling to continue, then I agree to discuss this first with my lay counselor and second (if necessary) with the leaders/pastors who oversee the lay counseling ministry. I have thoroughly read and agree to all statements regarding the lay counseling ministry at Christ Community Church. I hereby release and hold harmless Christ Community Church and lay counselors from any and all liability, claims, and/or expenses related to or arising from any care or counseling received (or not received).
Signature

Agreement Questionnaire
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Sex:
Marital Status:
Occupation:
Emergency Contact & Phone Number:

Are you experiencing suicidal thoughts? If yes, please explain.
What are the concerns that bring you in for an appointment?
What have you attempted to do about them so far?
Please list any medications you are currently taking:
Are you seeking counseling from a Biblical perspective?

Release of Responsibility

I understand, Christ Community Church has established this ministry with the intent of helping all people find freedom in following Jesus, particularly by way of the counseling process.

I will not hold Christ Community Church liable for the counseling I receive or thought I should have received. I am entitled to a copy of the disclosure statement I signed.
Signature
General Reminders:
- Lay Counseling is short term therapy (7 sessions max). A referral to a professional counselor may be necessary if client needs persist.
- It is free to see a lay counselor.
- As a courtesy, if you are unable to keep your appointment, please give 24-hour notice. CALL 910-690-3884 to cancel
- We want to serve you well, if there is any way we can improve our services, please let us know.
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Lay Counseling Agreement

Agreement Questionnaire