Client Information Form
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Name
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Session Selection
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Please read the terms of the Liability Release Form below. Check the 'Yes' box to confirm your agreement to the terms of the Liability Release Form.

Please Read The Liability Release below and submit the form above.

Liability Release for Teaching Kids For Life

 

This is an agreement between the client and Christine Battams.

IT IS AGREED

1. The client accepts that the session does not promise the alleviation of the client’s condition

2. In consideration of Christine providing the coaching/counselling service, the client agrees:

– The counsellor will be paid the above mentioned hourly rate and/or part thereof for the counselling service provided,

– If the client makes an appointment and fails to attend the appointment the counsellor will be entitled to be paid for the session unless the client gave more than 24 hours notice of his/her inability to attend the session.

3. The client accepts the risks involved in counselling and therapy and if anything in the client’s situation or circumstances changes in a way that will impact on the potential risks of counselling, the client will undertake to inform the counsellor immediately.

4. Any information provided by the client to the counsellor during the counselling sessions (“the information”) will be kept confidential unless:

– The session records are subpoenaed for court proceedings, or
– The counsellor suspects the client intends to harm him/herself or others, or
– The client discloses information to the counsellor concerning child abuse, or
– The counsellor passes on information to a supervising counsellor, or
– The counsellor is otherwise required to pass on the information by operation of law.