PERSONAL DATA INVENTORY


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Consent to Biblical Soul Care Harvest Bible Chapel – Davenport

Our Goal – Our goal in providing biblical soul care is to help you meet the challenges of life in a way that will please and honor the Lord Jesus Christ and allow you to enjoy fully His love for you and His plans for your life.

Biblical Basis – We believe that the Bible provides thorough guidance and instruction for faith and life (2 Peter 1:3 and Romans 15:4). Therefore, our soul care is based on scriptural principles rather than those of secular psychology or psychiatry. One of the principles that we emphasize is the wisdom of biblical community. Therefore, we invite advocates to be a part of the soul care process. The advocate comes along-side the counselee for prayer, encouragement, and accountability.

Not Professional Advice – Although some of the soul care providers of this church may be licensed in other fields, such as medicine or psychology, they do not practice as professional doctors, psychologists, or psychiatrists in their role as Harvest Bible Chapel soul care providers. In their Harvest role, they do not provide the same kind of professional advice and services that they do when they are hired in their professional capacities. Therefore, if you have significant legal, financial, medical, or other technical questions, you should seek advice from independent professionals, not associated with Harvest Bible Chapel Davenport. Our soul care providers will be happy to cooperate with such advisors and help you to consider their counsel in the light of relevant biblical principles. By signing this “Consent to Biblical Soul Care”, you agree to hold Harvest Bible Chapel and Dare to be Different harmless and blameless in any and all matters associated with the biblical advice you have received.

Confidentiality – Confidentiality is an important aspect of the soul care process, and we will carefully guard the information you entrust to us. However, because we are continually training others to be effective soul care providers, we ask that you agree to allow advocates or observers to be present during your sessions. There are four other situations when it may be necessary for us to share certain information with others: (1) When a soul care provider is uncertain of how to address a particular problem and needs to seek advice from another pastor or soul care provider in this church; (2) when a counselee attends another church and it is necessary to talk with his/her pastor or church leaders; (3) when there is a clear indication that someone may be harmed unless we otherwise intervene; or (4) when a person persistently refuses to renounce a particular sin and it becomes necessary to seek the assistance of others in the church to encourage repentance and reconciliation (see Proverbs 15:22; 24:11; Matthew 18:15-20). Please be assured that our soul care providers strongly prefer not to disclose personal information to others, and they will make every effort to help you find ways to resolve a problem as privately as possible.

Resolution of Conflicts – On rare occasions, a conflict may arise between a soul care provider and someone receiving soul care. In order to make sure that any such conflicts will be resolved in a biblical manner, we require all of our soul care recipients to agree that any dispute that arises with the soul care provider, or with this church as a result of biblical soul care, will be settled with mediation within the church according to the principles of scripture and the authority of this local church. Having clarified the principles and policies of our soul care ministry, we welcome the opportunity to minister to you in the name of Jesus and to be used by Him as He helps you to grow in spiritual maturity and further prepares you for fruitful ministry in His body. If you have any questions about these guidelines, please talk with a pastor or elder at Harvest Bible Chapel. If these guidelines are acceptable to you, please sign below. Signed: _________________________________________________

Date: _______________________________

BIBLICAL SOUL CARE APPLICATION

Date of Application: _________________

Please complete this form in its entirety. If you have questions/concerns about any of the requested information, please contact Jason Taylor, Pastor of Congregational Care at Harvest Bible Chapel. Completion of the Biblical Soul Care Application is necessary before a soul care provider can be assigned.

Identification Information: Name _______________________________ Email Address __________________________________________ Address _____________________________ City __________________________ State______ Zip___________ Best contact phone # (_____) ______________________ Alternate phone # (_____) ______________________ Date of Birth _______________________ Gender: (check one) Marital Status: (check all that apply)  Single  Living together  Engaged



Male



Female

 Married  Separated  Divorced  Remarried  Widow

Referred to Biblical Soul Care by ______________________ Their relationship to you _____________________ Who do you know best at Harvest? ______________________________________________________________ What do you think are the top 3-4 issues right now in your life? _______________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ What have you done about it? __________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________ What can we do? What are your expectations in coming here? ________________________________________ ___________________________________________________________________________________________ ___________________________________________________________________________________________