I, the undersigned, am the parent or legal guardian of the minor named below and have voluntarily sought the assistance of LiveWorthy / Christie Sparks for pastoral counseling services for said minor.
I acknowledge that I am under no obligation to accept or reject any of the advice or help that may be offered to the minor by LiveWorthy / Christie Sparks. I understand that participation is entirely voluntary and that I, on behalf of the minor, may terminate participation at any time and for any reason. I also understand that LiveWorthy / Christie Sparks may choose to terminate participation at any time and for any reason without liability.
I accept full responsibility for the decisions and outcomes that may result from the minor’s participation in counseling. I understand that premature termination of any therapeutic or spiritual intervention may have consequences, and I accept responsibility for any such outcomes.
I understand and accept that LiveWorthy / Christie Sparks is committed to maintaining confidentiality, with the exception of legally mandated disclosures, which include:
Confession of intent to commit suicide, homicide, or other violent acts
Confession or disclosure of child abuse by the minor or another person
I hereby release LiveWorthy / Christie Sparks from any and all liability, loss, or damage of any kind that may arise from the assistance provided to the minor or from their involvement in counseling services.
I further acknowledge, understand, and agree that, in partial consideration for the counseling provided, LiveWorthy / Christie Sparks and any of its employees, agents, or volunteers may, at their sole discretion, claim and assert any legal privilege available and may refuse to testify in any legal proceedings or court regarding any matter disclosed during counseling.
I also understand and agree that LiveWorthy / Christie Sparks and its representatives may object to subpoenas and assert legal privileges to prevent the disclosure of any notes, records, or files—physical, electronic, digital, or otherwise—related to counseling sessions with the minor.
In further consideration, I hereby waive, release, and relinquish any right I may have to compel the testimony of LiveWorthy / Christie Sparks, its employees, agents, and/or volunteers, or to subpoena any materials related to the counseling provided.
I understand that prior to signing this liability release, I have the right to consult an attorney or other counsel of my choice.
I also acknowledge that Christie Sparks is a clergy licensed pastoral counselor and is not a state-licensed professional counselor, therapist, psychologist, or psychiatrist.
I have read and understand this disclaimer and liability release. I agree to its terms and affirm that I am signing it freely and voluntarily as the parent or legal guardian of the minor.
