Disclaimer Form

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 give it to your facilitators.

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 Motherless Daughters courses. The volunteers and staff are neither state of Ohio licensed or certified professional counselors and therapists. The Motherless Daughters courses are not intended to be a substitute for professional counseling.

II. Prohibition of Weapons

You agree not to bring any weapons into the Motherless Daughters Ministry class or to the site.

III. Participation Agreement

You agree as a participant in the Motherless Daughters course 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.

IV. Reporting Requirements

There are certain occasions when the Mother Daughters Ministry facilitators may be required to report the following to an appropriate authority:

• If a class participant indicates a desire to harm him/herself or another person.
• If a class participant reports abusing children or the elderly in any way.
• If a class participant plans to commit a felony.

V. Release of Liability

I understand that in consideration of the benefits to be derived from my participation in the class 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 the or 6-week class.

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.

If I do not agree with the language in the preceding document, I will not be permitted to attend the Motherless Daughters Ministry class

I have read the preceding document; I have had the opportunity to ask questions and speak with the course facilitators about the preceding document; and I have also had a reasonable amount of time to review and reflect upon this document prior to signing.

Each party agrees that this Agreement and any other documents to be delivered in connection herewith may be electronically signed and/or initialed, and that any electronic signatures and/or initials appearing on this Agreement or such other documents are the same as handwritten signatures and/or initials for the purposes of validity, enforceability, and admissibility.