Groups - Restoration Group Application

Restoration Groups Application

Restoration Groups are 10-week counseling groups for men and women that are designed to help people find hope in the gospel together. Each week you share honestly with a small, trusted group about the pain of present suffering or sin and past hurts from your story and allow biblical trained counselors to apply gospel truth to those places.

New groups launch every February and September. Apply to reserve your spot for the next group.

General Information

Name*

First Name

Last Name

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Phone*

Email*

Birthday*

Age

Gender*

Male Female

Marital Status*

Single Married Divorced Separated Widowed

Winter/Spring Restoration Group

Will you commit to being present for every single session?*

Yes No

If no, please explain.

Will you need childcare?*

No Yes

Names and ages of children

Community Involvement:

What is your involvement at College Park Church?*

Member Regular Attender Do not attend College Park Church

Where do attend church?

Are you currently in a Small Group at College Park Church?*

No Yes

Who is your Small Group Leader?

Have you participated in any previous Group Counseling programs?*

No Yes

Name(s) of Group Counseling you have attended

Personal Information:

Why do you want to participate in a Restoration Group?*

Briefly, what are one or two themes in your story that you might be working on in your Restoration Group?*

Any further information you would like us to know?*

Group Counseling Consent Agreement

Please read carefully the following agreement then sign below:

Spiritual care is provided by College Park Church for the express purpose of providing biblical help for those who seek it. We believe Jesus came to bring healing to the way we think, behave, and feel. He declared:

"The Spirit of the Lord is upon me, because he has anointed me to proclaim good news to the poor. He has sent me to proclaim liberty to the captives and recovering sight to the blind, to set at liberty those who are oppressed, to proclaim the year of the Lord's favor (Luke 4:18)."

COMMITMENT

I will commit to the Counseling Group process, giving thorough attention to all Counseling Group assignments, including required reading chapter/workbook questions, and other personalized directions given to me by my group leaders.

CONFIDENTIALITY

Our Counseling Group Leader Team is committed to doing everything possible to guard the information our participants entrust to us. However, there are times when we are legally required and/or biblically obligated to share information with others. Some exceptions to confidentiality include, but are not limited to the following:

1. We are informed of an alleged or suspected child/elder abuse or neglect committed by or experienced by the participant or by a specifically identified individual.
2. The participant is a perceived threat to themselves or others.
3. A leader or supervisor is subpoenaed and ordered by a judge to testify or release client information.
4. If the participant is a member of College Park Church and we discern the need to discuss a participant's situation with his/her pastor/elder for the purpose of pastoral assistance.
5. The Restoration Group Leaders reserve the right to discuss your case with a supervisor for the purpose of quality care and direction.

I have thoroughly read and agree with the foregoing policies regarding Counseling Groups care provided at College Park Church. I hereby release and hold harmless College Park Church, its directors, officers, employees, and volunteers from any and all liability, claims, and/or expenses related to or arising from any pastoral care or counseling received (or not received).

I have also read and agree with the Consent to Counsel.

Signature*

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Use your mouse or finger to draw your signature above. If you have question about this agreement please contact RBerg@yourchurch.com