Schedule Appointment with Loving on Purpose Family Coaching

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Notes to Business (your address or any special notes about your order)

Item	Quantity	Total
Ben Serpell - Coaching Session		$150.00
Total: $150.00	Coupon:

I _________________________acknowledge that team members from Loving On Purpose have voluntarily agreed to meet with me with the goal to help me move toward healthy relationships. I understand that this session is not a professional counseling meeting and that none of the team members are licensed counselors. I understand that these team members are, to the best of their ability, doing what they can to help me achieve more freedom in my life.

I understand that Loving on Purpose is a nonprofit California Corporation that makes no charge for its services. I further state that I have voluntarily sought assistance of my own initiative and that I am under no obligation to accept or reject any of the advice or help that I might receive from the team members of this ministry.

Our team members offer Pastoral Counseling to anyone who desires it, regardless of ability to donate. We, therefore, have a suggested donation of $100, for individuals and $150 for couples. Your contributions to this ministry are greatly appreciated as they support our pastoral team and overhead cost. Any donations are tax-deductible, If you would like a tax-deductible receipt, we will provide one for you. Thank you!

I understand that if I receive ministry from Loving On Purpose Ministries, the team is committed to respecting the disclosed information, but not to complete confidentiality. The information, as needed, may be shared with other leaders of Loving on Purpose ministries so as to further your total healing process. This may include future meetings with spiritual mentors in the church to set appropriate boundaries for your personal and spiritual growth.

We are required by law to report two issues:

1.1.Any intent of a person to take harmful, dangerous, or criminal action against another person or against him/herself.

2.2.Any act of child or elderly abuse or neglect.

I agree to hold Loving on Purpose and its team members free from any and all liability, loss or damage of any kind that may arise as a result of assistance that I have received or from my involvement with Loving on Purpose.

I have read this disclaimer and release of liability and understand and agree with it and have executed it as my free and voluntary act.