Informed Consent Form (Minor)

Our Goal

The purpose of the Biblical Counseling Ministry of Richland Creek Community Church is to help fellow believers glorify God with their thoughts, words, and actions, which is made possible by the redemptive power of Jesus Christ, the conviction and guidance of the Holy Spirit and the instruction of God’s Word.  The ultimate goal is to lead people to an understanding of what it means to be a true follower of Jesus Christ.

Biblical Basis

We are confident that the Bible has all the instruction necessary for life and godliness (2 Peter 1:3-4).  Your child’s counseling will be biblically based counseling in which the Scriptures are, in all cases, the final authority (2 Timothy 3:16-17). Our counselors do not pretend to know all there is to know about biblical teaching and its application to life; nevertheless, they do know much and will do their utmost to help your child. While we believe that the Bible speaks to all of life and to all of its problems, we also believe that sometimes it takes careful thought and prayerful wisdom to know how to make those connections.  Our counselors are trained to help guide your children in applying biblical wisdom, but will honestly tell you and your child if they require additional assistance from another member of the Biblical Counseling Ministry.  It should be understood that biblical counseling consists of giving scriptural advice and the practical application of the same to each individual. Yet your child is held fully responsible for how he or she implements that advice (James 1:23-25). If you are not sure that you or your child will be interested in biblically-based counseling, your child will be given the option of attending one or two sessions to discover what biblical counseling is like.

The Biblical Counseling Team

The ministry team consists of pastors, lay counselors, and trainees under the direction of Associate Pastor John Wright and Counseling Pastor Tony Donato. The use of the word “counselor” in this document can equally refer to a pastoral counselor, biblical counselor, or a lay-person trained in biblical counseling.  Counseling trainees may be invited to join the counseling sessions, as required and determined by the Counseling Pastor, to observe the counsel; however, they are bound to the same requirements of confidentiality as stated below.

The Biblical Counseling Ministry is not a professional service.  The counselors are not trained as and do not counsel as licensed psychologists, licensed psychiatrists, state certified therapists, or any other type of professional mental health care provider.  Consequently, as they should not be expected to follow the methods and standards of such specialists, and under North Carolina law, no such licensing is required. Their purpose is to minister from the Word of God as peers of the counselees. There will be no attempt to render a psychological evaluation or diagnosis.  If you have significant legal, financial, medical, or other technical questions, you should seek advice from an independent professional.

Key Points, Requirements for Counselees, and Reasons for Termination

  • Counseling services are available to anyone in the community; however, counseling members of Richland Creek Community Church always takes precedence over counseling non-members.  When a counselor is available, non-members may be scheduled for counseling.
  • Counseling wait times can be extended for non-members when Richland Creek church members request counseling; however, once counseling of non-members begins, the sessions will continue to completion without interruption.
  • All minor counselees and their legal guardians are required to attend a weekly worship service and Life Group meeting at Richland Creek while counseling.  If you are a member of another church, this requirement still applies while receiving counseling services.  Additionally, we will inform one of your pastors that your child is receiving counsel at Richland Creek.  We do this, because we recognize and respect the authority of local churches; and this makes transfer back to the pastoral care of your church easier to affect.  Consistent failure to meet the worship and Life Group attendance requirement will result in termination of counseling.
  • Counselees will be asked to complete a Personal Information Collection form in order to aid the counselor in seeking biblical answers to the issues facing the counselee(s). Depending on your child’s age and ability, a parent may be asked to complete the form for the child.
  • Homework is assigned at each meeting. Homework is an essential part of the learning process and forms the basis of discussion for many sessions. Homework is also designed to facilitate personal time with God during the week, which is a critical part of the counseling process.  The counselee commits to complete all assignments before each meeting.  Continued lack of completion of homework will lead to termination of counseling.
  • As previously mentioned, the Bible is used as the final authority for biblical counseling.  If the counselee is unwilling to use the Bible as such, then the counseling will be ineffective and thus the sessions will be terminated.
  • Your assigned counselor will contact you directly to set up your child’s first meeting and will then discuss, at the first meeting, the process for setting up future meetings.
  • If a counselee is unable to keep an appointment, he or she must contact his or her respective counselor to cancel in a timely manner. Notification of cancellation is expected at least 24 hours in advance.  Consistent failure to do so or two consecutive cancellations without good cause will result in termination of counseling.  Not showing up constitutes canceling.  We understand emergencies happen, so please keep us informed. We appreciate your cooperation in this matter, as our lay counselors freely give their time to this ministry.
  • At any time during the counseling, the counselor or the counselee has the option of terminating counseling.


Confidentiality is an important aspect of the counseling process. We carefully guard the information that you and your child entrusts to us to the fullest extent possible. However, we do not promise absolute confidentiality. Your counselor reserves the right to consult with other counselors or pastors at Richland Creek for the purpose of providing the highest level of care. Additionally, there are times when counseling information may be shared outside the Richland Creek context. Those exceptions would include, but are not limited to the following: (1) known or suspected child abuse or elderly abuse of any kind; (2) the intent to take criminal actions or violence against another person; (3) active suicidal thoughts or intentions; and; (4) other credible intent to harm self or others; and (5) matters of church discipline (see Matthew 18:15-17).  Counselors reserve the right and discretion to contact any and all appropriate entities when, as a result of the counseling, it is clear that a crime has been committed or is about to be committed or the safety and the welfare of any person (including the counselee) is in jeopardy.  The counselor is not required to notify the counselee or the parent in advance of any such contact with the appropriate entities.

Our counselors will periodically update parents on the status of the meetings and will provide, at their discretion, important information to assist you in parenting your child.

In each counseling office at Richland Creek there may be closed circuit video cameras. These cameras record picture only. They do not record voice. Video records are securely stored and made a part of Richland Creek’s permanent records. Cameras are used exclusively for office protection and liability reduction.

Please be aware that your child’s counselor is not a licensed psychologist, licensed marital or family therapist, or licensed counselor under the authority of any state or national certifying board or organization.  Consequently, communications between your child and his or her counselor (or between you and their counselor) are not considered privileged communications as defined by North Carolina law.  This means that, in a legal proceeding, a judge may compel disclosure of any statements made to the counselor.


Gifts to the Ministry

All counseling is done free of charge as a ministry of Richland Creek Community Church. Sometimes, out of gratitude, one may wish to express thanks in a tangible way. If our ministry has been a blessing to you and God has given you the means to do so, then your financial gift, above and beyond your normal tithe, is most welcome. In such cases, checks should be made out to the Church, rather than to a particular pastor or counselor, noting that it is for the Biblical Counseling Ministry.

Release of Liability

My electronic signature below indicates my informed consent to the above guidelines and I have discussed them with my child. Additionally, by signing this document, I am, of my own free will, knowingly authorizing the Biblical Counseling Ministry of Richland Creek Community Church to render Biblical counseling and/or referral services to my minor child. I declare that both I and my minor child are fully capable of discerning good and bad advice, and release my counselor, Richland Creek Community Church, its Elders, staff, employees, or any other associated ministry or organization from any legal liability, claim, or litigation arising from my child’s participation in this voluntary ministry. I affirm that no guarantee or assurance of any kind has been made to me or my child with respect to the expected results of counseling. I have been informed of the nature and purposes of Biblical counseling and that my consent can be revoked orally or in writing prior to and/or during the counseling session.

Furthermore, I understand that the counselor assigned to my child is not licensed, nor is required to be licensed, by the State of North Carolina or any national certifying organization, as a professional counselor, fee-based counselor, social worker or therapist. I understand that my child will not be given a psychological diagnosis based on the current Diagnostic and Statistical Manual of Mental Disorders. I also understand that those who provide care are not trained as and do not counsel as licensed psychologists, licensed psychiatrists, state certified therapists, or any other type of professional mental health care provider. I understand that my child will receive Biblical guidance based on the teachings and authority of God’s Word.

In signing this document, I (we) affirm that I (we) are the legal guardians of the minor child who will receive counseling; and I (we) are committed to glorifying God in our parenting and family life.

Having clarified the principles and policies of our counseling ministry, we welcome the opportunity to minister to you and your child in the name of Christ and to be used by Him as He helps your child grow in spiritual maturity and prepares him or her for usefulness in His body. If you have any questions about these guidelines, please review them with your counselor.



Name of Your Child
Father's or Guardian's Name - please note if father is deceased or has no legal custody.
Mother's or Guardian's Name - please note if mother is deceased or has no legal custody.
Name(s) of Parent(s) or Guardian(s) agreeing to conditions of counseling
I/(We) have read the conditions for counseling set forth in this Informed Consent Form and agree to release Richland Creek Community Church, its Elders, staff, counselors, and employees from any legal liability, claim, or litigation arising from my or my child's participation in this voluntary ministry. Click YES if you agree. Then, click "Continue".
  • Yes
Please enter an email address for communication purposes, when necessary.
Please enter a phone number for communication purposes, when necessary.