HopeForWellness
Counseling & Life Coaching Referral Program
Waiver and Release of Liability Agreement
Program Overview and Purpose:
The HopeForWellness Counseling and Life Coaching Referral Program, offered by New Hope Missionary Baptist Church and supported by New Hope In-Action CDC, provides individuals, couples, groups, and families with access to mental health counseling, coaching, case management, educational workshops, and wellness groups. Participants can select their preferred providers, who will deliver services according to their professional standards. New Hope Missionary Baptist Church will cover the cost of approved services, provide referrals to service providers, and offer access to physical locations or Telehealth facilities for treatment. This waiver applies exclusively to services facilitated and funded by the program.
Important Notice:
The services offered through this program are not a replacement for emergency services. If you or anyone you know is having thoughts of harming themselves or others, please seek immediate help by contacting emergency services or calling 911. Additionally, this program does not replace or negate any current treatment plans established by your primary care provider (PCP). It is advised that you consult with your provider before seeking services outside of their knowledge and care. If you have severe mental health issues, this program may not be the best option, and you are encouraged to seek ongoing care from a qualified provider.
While we always strive for positive outcomes and support all participants in their journey, the safety and well-being of both participants and service providers are of the utmost importance. In the event that a service provider deems a participant to be a danger to themselves or to others, the participant may be removed from the program immediately and without prior notice. Upon removal, no further services will be provided under this program, and the participant will not be eligible for any additional support through this initiative.
Waiver and Assumption of Risk:
In consideration of the opportunity to participate in The HopeForWellness Counseling and Life Coaching Referral Program, I acknowledge and accept the potential risks associated with engaging in mental health counseling, coaching, case management, educational workshops, wellness groups, or related services. I voluntarily assume these risks, understanding that participation in this program and the use of recommended providers are entirely at my own risk. I acknowledge that New Hope Missionary Baptist Church and New Hope In-Action CDC are not responsible for the care standards, practices, or outcomes associated with my chosen service provider.
I hereby release and forever discharge New Hope Missionary Baptist Church, New Hope In-Action CDC, Pastor Ryan F. Jackson, their affiliates, agents, staff, volunteers, successors, and assigns from any liability or claims, including physical, psychological, economic, or emotional injury, illness, or other loss arising from my participation in this program or my engagement with selected service providers. This waiver remains in effect only for services provided through and covered by this program.
Indemnification and Hold Harmless Agreement:
I agree to indemnify and hold harmless New Hope Missionary Baptist Church, New Hope In-Action CDC, Pastor Ryan F. Jackson, and their representatives against any and all claims, demands, suits, or actions of any kind for liability, damages, or compensation arising from my participation in this program or the selection of a service provider, including attorney’s fees and any related costs. If litigation arises from any claims made by me or on my behalf, I agree to reimburse New Hope Missionary Baptist Church and New Hope In-Action CDC for any related expenses incurred.
Acknowledgement of Program Limits:
I understand that New Hope Missionary Baptist Church and New Hope In-Action CDC facilitate access to licensed mental health professionals, coaches, case managers, and group therapists but do not provide mental health treatment, coaching, case management, or group therapy services directly. The program is limited to covering the cost of pre-approved services from providers within the program’s network, and the terms are subject to change.
Release of Liability and Assumption of Risk:
I acknowledge that I have carefully read this Waiver and Release of Liability and fully understand that it is a release of liability. I expressly agree to release New Hope Missionary Baptist Church, New Hope In-Action CDC, Pastor Ryan F. Jackson, and their affiliates from any and all claims or causes of action and agree to waive any rights to pursue legal action against them in connection with my participation in the program. To the extent permissible by law, this waiver includes release from any negligence on the part of New Hope Missionary Baptist Church, New Hope In-Action CDC, and their representatives.
Medical and Financial Responsibility:
I understand that in the event I require emergency medical treatment due to participation in the program, I am responsible for any associated costs not covered by the program. I acknowledge that I am responsible for maintaining my own health insurance coverage.
Interpretation and Severability:
This waiver is entered into voluntarily, without duress or coercion, and is intended to be clear and comprehensive. If any provision of this waiver is deemed invalid or unenforceable, the remainder shall continue in full force and effect, interpreted as necessary to fulfill its intended purpose.
By signing electronically below, I acknowledge that I have thoroughly read and fully understand The HopeForWellness Counseling and Life Coaching Referral Program Waiver and Release of Liability, and I hereby agree to its terms.