Coaching Disclaimer Thank you for choosing the Motherless Daughters Ministry to serve you! We are blessed by you. Motherless Daughters Ministry, Inc. Disclaimer, Participation Agreement, and Release of Liability Instructions: Please read the following statements and place your initials where indicated. Please write your name and date at the end of this document and submit this. You will need to complete and return this prior to starting your coaching. Date MM slash DD slash YYYY I. Disclaimer The Motherless Daughters Ministry does not provide professional medical, psychiatric, psychological, counseling, or social work services. The services provided by the Motherless Daughters Ministry volunteers and staff are not intended to be regarded as a substitute for medical, psychiatric, or mental health services. The Motherless Daughters Ministry is operated by volunteers and staff trained to facilitate and coach Motherless Daughters. The volunteers and staff are neither state of Ohio licensed or certified professional counselors and therapists. The Motherless Daughters coaching is not intended to be a substitute for professional counseling. Initials II.Prohibition of Weapons You agree not to bring any weapons into the Motherless Daughters Ministry if on site. Initials III. Participation Agreement You agree as a participant in the Motherless Daughters Coaching that you assume the complete and sole responsibility to seek out or maintain spiritual, medical, psychiatric, or mental health care (hereinafter “care”) as needed; the Motherless Daughters Ministry staff or volunteers are not assuming any role in your care. Initials IV. Reporting Requirements There are certain occasions when the Mother Daughters Ministry facilitators/coaches may be required to report the following to an appropriate authority: • If a participant indicates a desire to harm him/herself or another person. • If a participant reports abusing children or the elderly in any way. • If a participant plans to commit a felony. Initials V. Release of Liability I understand that in consideration of the benefits to be derived from my participation in coaching offered by the Motherless Daughters Ministry Inc., I hereby release and forever discharge and covenant not to sue or hold legally liable the Motherless Daughters Ministry, Inc., its governing board, staff, employees, or volunteers from any and all claims, demands, actions, or causes of action of whatsoever kind and nature related to my participation in coaching. I understand that if any provision or part of this document including the Release of Liability is found to be invalid or void as against public policy or by any court of jurisdiction, the remainder of this document shall remain in full force and effect. Initials If I do not agree with the language in the preceding document, I will not be permitted to attend the Motherless Daughters Ministry Coaching Participant Signature Motherless Daughters Ministry, Inc., Coach CommentsThis field is for validation purposes and should be left unchanged. Δ
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