I/we desire to receive counseling and ministry from Delaware Bible Counseling and Discipleship Ministries, Delaware, Ohio (“DBCADM”). I/we make the following acknowledgements and agreements and give the following consents:

1. The counseling will be by a counselor who is trained in biblical counseling who may or may not have other certifications or degrees.
2. A basic principle of biblical counseling is that the Bible is sufficient to understand how to live a God-pleasing life.
3. The counseling I/we will receive will be based upon scriptural principles rather than principles of psychology or psychiatry.
4. The counseling I/we will receive will be based on the conclusions that the Bible is inerrant and authoritative, and contains God’s answers to the issues of life, conduct and relationships.
5. The counseling I/we will receive will reflect the counselor’s understanding of the Bible and how the principles of Scripture apply to the problems, questions or issues involved.
6. Because DBCADM is also a training ministry, trainees (i.e. those being trained in biblical counseling) may be present in the counseling sessions and they will abide by the confidentiality articulated in #8 below.
7. DBCADM wants to be a blessing to the community by providing facilities and counselors who volunteer their time and services. While the counseling is free there is a $25.00 cancellation fee payable in cash at the first counseling session. If an appointment is cancelled less than 24 hours before the scheduled time for counseling, the counselee will forfeit the cancellation fee and he or she must submit another $25.00 in cash before continuing in counseling. If all sessions are attended or cancelled in a timely manner, the cancellation fee will be returned at the final counseling session.
8. Counseling at Delaware Bible Church, including statements made during the counseling, shall remain confidential, with the following qualifications and exceptions:
   1. Counselors shall be free to discuss counseling sessions and cases with other DBCADM counselors and the pastors of Delaware Bible Church, Delaware, Ohio in order to gain the benefit of additional insight and input;
   2. Counselors and pastors shall be entitled to seek a confidential legal opinion or advice from an attorney when it is deemed appropriate and helpful;
   3. If any DBCADM policy concerning the reporting of child abuse or child neglect, or the reporting of elder abuse or elder neglect, mandates a report to Child Protective Services or other authorities in compliance with the laws of the State of Ohio, then such a report will be made;
   4. If a suicide risk is indicated, the counselors or pastors may seek necessary help and make whatever reports or disclosures as they deem to be proper and necessary;
   5. If a counselee indicates an intention to commit a crime, such intention may be reported and disclosed to the proper authorities;
   6. If the counselee is a member or attendee of a local church other than Delaware Bible Church, and if the pastors of Delaware Bible Church deem it necessary or helpful to communicate information or facts to the pastor of the counselee’s local church, they may do so. The counselee will be informed prior to any information or facts being communicated to their pastor.