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RELEASE OF LIABILITY FOR PRE-MARTIAL COUNSELING SERVICES (Mudiwa LLC (4thisreason.org)) State of County of

FOR AND IN CONSIDERATION OF Mudiwa LLC (4thisreason.org)(HEREAFTER called Mudiwa LLC (4thisreason.org) provision ofpre-marital counseling services, the undersigned, being legally competent and fully authorized and empowered to do so, does hereby RELEASE, ACQUIT, AND FOREVER DISCHARGE Mudiwa LLC (4thisreason.org) AND ALL PARTICIPATING COUNSELORS CONNECTED WITH SAID Mudiwa LLC (4thisreason.org), from any and all actions, courses of action, claims, demands, damages, costs, loss of service, expenses and compensation, on account of any and all known personal injuries, mental anguish or agitation, and damage claims to person or property resulting from or arising out of or related to counseling services provided by Mudiwa LLC (4thisreason.org) and/or its, representatives and/or employees in any way affecting the undersigned parties.

By law, there are certain situations in which information about individuals undergoing counseling may be released with or without their permission. These situations are as follows: 1. Where children are physically abused, neglected, or sexually abused, the proper authorities must be notified. 2. In emergency situations where there may be danger to the client or others, as with homicide or suicide, confidentiality may be broken. 3. If a court of law issues a legitimate subpoena relating to a child abuse case, we are required by law to provide the information specifically described in the subpoena. 4. If an unreported life-threatening felony has been committed, we are required by law to report it to the police. Before warning or notifying anyone, the counselor will first take all possible steps to share the intention with the undersigned parties.

The undersigned parties fully understand the nature of counseling services to be provided and have been fully explained to them prior to receiving such services, and they freely enter into such counseling services with full knowledge of the nature of the pre-marital counseling they are about to receive. The undersigned fully understand the nature of a pre-marital counseling services such as that offered by Mudiwa LLC (4thisreason.org), and nevertheless, waive and release all mental problems claims for damages to their person or property arising out of or in any way related to the psychological, spiritual, and/or and the counseling directed at such problems which havebrought the undersigned to Mudiwa LLC (4thisreason.org).

The undersigned further AGREE to indemnify, have and hold harmless Mudiwa LLC (4thisreason.org), its counselors and employees from any and all claims and damages of every kind to person or property arising out of or attributed to the spiritual, psychological, and/or mental problems which brought the undersigned to Mudiwa LLC (4thisreason.org), or the undersigned at any point after the date of this release.

IT IS FURTHER UNDERSTOOD AND AGREED that this waiver and release constitutes an admission and acknowledgment by this undersigned that they have received no warranty, guarantee, or promise of any particular result either expressed or implied, from Mudiwa LLC (4thisreason.org), or its pastor, or representatives. The undersigned parties acknowledge and agree that the very nature of their problem(s) is necessarily such that no specific result(s) can be promised or warranted by any such ministry or counseling service.

This release contains the entire agreement between the parties hereto, and the terms of this waiver and releaseare contractual and not mere recital.

The undersigned further states they have carefully read the forgoing release, know the contents thereof, and sign the same of their own free act and deed.

Disclosure
As a Member at Bethel’s Family and participating in the Sacred Covenant Marriage Ministry (SCMM), We are called by God to help people understand and experience God’s love, which is freely offered. We believe that God’s love, expressed through His truth, gives our lives direction and purpose with personal freedom, the end result.

Our fervent desire is twofold:
1. To see people grow in their trust of and obedience to God; and 2. To see people develop healthy relationships with themselves and others.
We will not force people to change, nor allow dependence that would in any way inhibit their independent thinking.
We will attempt, with God’s direction, to encourage, instruct, correct and train people to understand and apply biblical truth to their lives.

In the light of these beliefs, our personal counseling guidelines are as follows:
We are not professionally trained in psychology. We are biblical counselors, available to encourage you in seeking counsel from the Bible and through prayers.
We will ask God for discernment and then allow you the freedom to react in the way that is most responsible for you. Remember the Bible is our authority for Faith (what we believe) and practice (our behavior).
Our formal time spent together will be based on meeting your needs that produces wholeness. If we ever reach an impasse, at that point we may suggest a professional counselor.
Recognizing the possibility of role confusion and the value of friendships, we believe it is best not to counsel friends. However, we are happy to refer personal friends to other counselors.
We counsel as a team (husband and wife or another third party) with the opposite sex. In no way will we counsel the opposite sex alone.
Some specific issues may require other skills we do not possess. These include deeply imbedded behavioral problems and severe forms of addiction, sexual disorders and abuse. For your sake, we entrust these areas tothe care of a Christian professional and prayerfully support the process toward spiritual and biblical life change.
All information in a counseling session is confidential. We may seek out advice and supervision from another professional, but your name or identity will not be used without your permission. However, we are required to report to the appropriate authorities certain serious situations, according to the laws of our state.
At times, when our own spiritual reservoir needs replenishing, we will refuse to counsel others. Rather than represent a lack of interest in those of you seeking counseling, it is a sign of my great respect for you and your needs. We will happily encourage a referral.
Our primary goal is to point you to the Savior. We have no special access to Him that you do not share if you are a child of God. Our prayer is that in our counseling relationship, we look together to Him and find the abundant life He promised.
Date Counselor’s Signature Counselee’s Signature