Real Life Church Ministries
Release of Liability for Counseling Services Referral
Real Life Church Ministries (“RLCM”) has established a program to assist its members in obtaining general counseling services. Upon application by a member, RLCM will provide contact information for a licensed counselor (the “Counselor”) and, upon the member arranging for the initial consultation with the Counselor, RLCM will pay the cost for the initial consultation (the “Referral Service”). The member will be responsible for the cost of any subsequent sessions with the Counselor. This program is for general counseling, not in-depth counsel or treatment, and is not intended for anyone who may be suicidal.
By completing this Release of Liability, the person identified below (“Client”) requests to participate in the Referral Service and agrees that, for and in consideration of the provision of the Referral Service, Client (being legally competent and fully authorized and empowered to do so) does hereby release, acquit, and forever discharge RLCM and its directors, officers, employees, agents, representatives, and insurers (collectively, the “RLCM Parties”), from any and all injuries, damages, losses or claims, whether known or unknown, related to the psychological, spiritual, and/or mental problems of Client, or which arising during or result from Client’s participation in the Referral Service or the counseling services to be provided by the Counselor.
Client further agrees to indemnity and hold harmless the RLCM Parties, and each of them, from any and all injuries, damages, losses, claims, costs or expenses (including, without limitation, attorneys’ fees and other litigation costs and expenses) incurred by any RLCM Party as a result of any of claims or demands of any kind that Client (or anyone claiming by, under or through Client) may bring against any of the RLCM Parties to recover for any injuries, damages, losses, claims, costs or expenses arising out of or attributed to the psychological, spiritual, and/or mental problems of Client or Client’s participation in the Referral Service or counseling with the Counselor; provided that the foregoing indemnity shall not extend to any such claims or demands arising out of the gross negligence or willful misconduct of any RLCM Party.
It is further understood and agreed that this Release of Liability constitutes an admission and acknowledgment by Client that Client has received no warranty, guarantee, or promise of any particular result, either expressed or implied, from any of the RLCM Parties. Client acknowledges and agrees that the very nature of the problems of Client to be addressed is necessarily such that no specific results can be promised or warranted by any counseling services.
This Release of Liability contains the entire agreement between Client and RLCM with regard to the subject matter hereof, and the terms of this Release of Liability are contractual and not mere recitals.
Client further confirms (by checking the box below) that Client has carefully read the foregoing Release of Liability, knows the contents thereof, and accepts and agrees to the same of Client’s own free act and deed.
PLEASE ONLY SELECT ONE COUNSELING SESSION
We please ask that you only select ONE counseling session below. With limited slots available, we want to make sure that everyone has the ability to meet with a counselor.