I voluntarily agree to the nouthetic counseling provided by Hobart Assembly of God, Inc.  I understand and recognize that such nouthetic counsel consists of guidance pertaining to ideals, beliefs and Scripture as interpreted and ministered by the above named, who has completed the training established by NAME (National Association of Marriage Enhancement) and received the association's designation of certified marriage specialist (CMS).

I recognize and understand I am not receiving secular or psychiatric, psychometric, or psychological counseling.

I undertand and recognize that the above named nouthetic counselor is not a licensed mental health care provider, and the above named nouthetic counselor is not holding himself/herself out as a "psychiatrist," "psychometrist," or "psychologist" nor is his/her guidance considered "psychatry," "psychometric," or "psychology."

I acknowledge and understand that this acknowledment and consent has the same force and effect regardless of whether the nouthetic counseling activities are free instead of a fee being charged for consultation.

I acknowledge and understand that the nouthetic counseling received from teh above named nouthetic counselor does not and will not assess, diagnose, correct, treat or counsel in a professional relationship to assist in, among other things, the following:  (a) alleviating mental or emotional illness, symptoms, conditions, or disorders, including alcohol or drug addiction; (b) understanding conscious or subconscious motivations; (c) resolving emotional, attitudinal , or relationship conflicts; or (d) modifying feelings, attitudes, or behaviors that interfere with effective emotional, social or intellectual functioning, and in the event such advice is given concerning these proglmes of the like, such advice is not given in a professional capacity, but is given by the above named only in his/her recognized capacity as a biblically-based nouthetic counselor, wihtout any further representation of professionalism.

I acknowledge and understand it is my obligation to inform the above named nouthetic counselor, prior to a nouthetic counseling session, that I do not desire to participate in nouthetic counseling, but rather, I am seeking to establish a professional relationship with a mental health service provider.

I acknowldedge and understand that I take full responsibility fo rdecisions made by me after this counseling session.

I understand that NAME acts as a training association and designations are for the purpose of identifying completed training, wihtout further responsibility.

I have fully informed myself of this Nouthetic Counseling Acknowledgment and Consent by reading and understanding it before signing it.