I desire to receive counseling from West Center Biblical Counseling, in Madison, SD.  I make the following acknowledgments and agreements and give the following consents:

• 1. The counseling will be given by a counselor who is trained in biblical counseling who may or may not have other certifications or degrees.
  2. The counseling I will receive is a ministry of West Center Baptist Church operating according to the church’s Statement of Faith and biblical principles. WCBC believes the Bible is sufficient to help every person receive eternal salvation and live a purposeful and hopeful life.
  3. The counseling I will receive is based on the belief that the Bible is God’s word, inerrant, and authoritative for all beliefs and behaviors.
  4. The counseling I will receive will reflect the counselor’s understanding of the Bible and how its principles apply to the questions, problems, and struggles shared.
  5. The counseling I will receive is NOT from a psychologist, psychiatrist, mental health therapist, or licensed social worker.  I will not be given legal or medical advice by the counselor but may be referred to experts in these fields when deemed needed and helpful.
  6. If not a member of West Center Baptist Church, I understand the expectation to attend weekly church services at West Center Baptist or a church recommended by West Center Baptist while being counseled.
  7. WCBC offers counseling free of charge.  Donations to the counseling ministry are accepted but not required.  I understand that the purchase of books or resources may be necessary as part of the counseling process, and I agree to pay for those resources.
  8. Because WCBC also seeks to train future counselors, trainees (those being trained in biblical counseling) may be present in a counseling session and will abide by the confidentiality statement in section.
  9. If a dispute arises concerning the counseling of WCBC, or between a counselee and counselor, or with West Center Baptist Church (“the dispute”), there shall be no lawsuit initiated and the claim cannot be filed in any state or federal civil court.  Instead, the dispute must be resolved as follows:

The parties hereby exercise their election, as provided in South Dakota’s Enforcement of Arbitration Agreements Act (Stat 21-25A-1 to 21-25-A-38) to submit any disputes or claims to Christian resolution. The parties understand that the Bible commands them to make every effort to live at peace and to resolve disputes with each other in private or within the Christian church (see Matthew 18:15-20; 1 Corinthians 6:1-8). If all parties agree, the dispute can be submitted to the binding arbitration decision of agreed-upon local pastors and/or church leaders who would decide and judge between the parties, applying all relevant biblical principles. The parties understand that Christian dispute resolution methods shall be the sole remedy for any such dispute or claim. The parties further agree that if they fail to agree to submit the dispute or claim to local pastors and/or church leaders, then they hereby agree that any such claim or dispute arising from or related to the counseling at and by West Center Biblical Counseling, or with West Center Baptist Church shall be settled by legally binding Christian arbitration, in accordance with the ICC Rules of Procedure for Christian Conciliation of the Institute for Christian Conciliation, a division of Ambassadors of Reconciliation (844-447-2671), including its Rules as found at www.aorhope.org/icc-rules.

1. 10. Counseling at WCBC, including statements made during counseling, shall remain confidential, with the following qualifications and exceptions:
       
       1. Counselors shall be free to discuss counseling sessions and cases with other WCBC counselors and the pastors/elders of West Center Baptist Church in order to gain the benefit of additional insight and input.
       2. Counselors and pastors/elders shall be entitled to seek a confidential legal opinion or advice from an attorney when it is deemed appropriate and helpful.
       3. If any West Center Baptist policy concerning the reporting of child abuse or child neglect, or the reporting of sexual assault, 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 South Dakota, then such a report will be made.
       4. If a suicide risk is indicated, the counselors or pastors/elders may seek necessary help and make whatever reports or disclosures they deem 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/regular attender of a local church other than West Center Baptist, and if the pastors/elders of West Center Baptist deem it necessary or helpful to communicate information or facts to the pastor of the counselee’s local church, they may do so.

I HAVE READ AND UNDERSTAND THE ABOVE PROVISIONS, AND I HEREBY ACKNOWLEDGE AND AGREE TO ALL OF THE ABOVE TERMS, INCLUDING, BUT NOT LIMITED TO, THE WAIVER OF SEEKING REDRESS (LAWSUIT) IN THE CIVIL COURT SYSTEMS, AND AGREEING THAT ANY AND ALL DISPUTES BE RESOLVED THROUGH CHRISTIAN RESOLUTION AS DETAILED ABOVE.