Consent Information for Yoga & Spiritual Direction Participants
Exploring Peace Ministries, LLC
with Whitney R. Simpson
I offer ecumenical spiritual care services for individuals and groups who seek to explore God’s peace in their lives through the art of spiritual direction and yoga. I am a member of the Fellowship of United Methodist Spiritual Directors and Retreat Leaders, Yoga Alliance, and Spiritual Directors International and follow the guidelines for ethical conduct of these organizations (a copy of these guidelines is available for review). I am also a 500-hour certified yoga instructor, 200-hour registered yoga teacher, and received my professional certification in spiritual formation as a spiritual director and retreat leader through Garrett-Evangelical Theological Seminary and the United Methodist Church's Global Board of Higher Education and Ministry.
Payment
The fee for private professional services is $75 per one-hour sessions and $35 per half-hour sessions (paid at the time of the session with Venmo, cash, check, or invoiced to your organization). If financial assistance is needed, please contact Whitney directly to discuss alternate methods of payment or an available sliding scale. Consider your financial payment as support of this ministry, as your commitment extends beyond the hourly session, providing safe spaces for others to listen for God as well.
Time of Sessions and Changes
We both commit to begin and end our sessions on time, sessions are scheduled for 60 minutes. You will receive a calendar appointment for sessions. If you wish to change your appointment, please let me know at least 24 hours in advance by rescheduling. You may email me or leave a voicemail or text on my work mobile number at 615.200.7255. If I were to experience an emergency need in rescheduling, I will contact you directly as well.
Confidentiality
I will hold our conversations in strict confidence. Our time together is sacred. I will not reveal the content of our conversations unless I am required to do so by law or court order. On the other hand, you are free to share whatever you choose about our time with anyone. Spiritual direction has impacted my journey greatly and it is something I share about often and process with spiritual friends and mentors. However, I will not release information about our session without your permission, except under the following required circumstances:
1. when there is threat or risk of self harm (suicide), or harm to another person (homicide)
2. when there is “reasonable cause” to suspect abuse or neglect of a child, disabled or elderly person, from
anything reported in a direction session.
3. when I receive a subpoena issued from a judge or court.
4. when a directee waives privilege by bringing charges or filing a suit.
Supervision
As part of my professional practice I consult with other spiritual directors through spiritual direction supervision. Your identity will never be revealed during this time. If you have any questions or concerns about this practice, please let me know and I will be happy to talk about it with you.
Our Relationship
We are meeting together for a time of spiritual care in order to examine your spiritual life with God. These sessions are not meant to be a substitute for professional counseling. While there is some overlap, counseling primarily focuses on one’s relationship with others and the issues surrounding them or on a particular situation in which one is seeking resolution, while spiritual direction focuses on one’s relationship with God. Sometimes God brings issues to the surface that need to be worked through and require the help of professional therapy in addition to or in lieu of our time together. You also recognize that spiritual direction does not include financial, professional, relational or health care advice and any decisions or actions you take in that regard are done without the advice or recommendation of myself or the organizations of which I am affiliated. You understand that the modality of yoga is sometimes included in a private session. Yoga includes physical movements as well as an opportunity for relaxation, stress reduction and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If you experience any pain or discomfort, you are asked to listen to your body, discontinue the activity, and ask for assistance. In addition, you will make me aware of any medical conditions or physical limitations before our time together. If you are pregnant, become pregnant or are post-natal or post-surgical, you verify that you have your physician's approval to participate in any physical activity.
Consent for Yoga Participation
I hereby consent for myself and agree to assume all of the risks involved. I understand that Exploring Peace Ministries, LLC/Whitney R. Simpson DBA Bloom Yoga Studio does not provide medical insurance relative to accidents, injuries, and/or death as a result of program related activities or advice; and that I can not hold them responsible for any liability. I recognize that any form of physical activity is a potentially hazardous one, and that they involve a risk of possible injury or even death. I hereby affirm that I am voluntarily participating in these activities with the knowledge of the risk involved. I agree to expressly assume and accept any and all risks of injury and/or death. I hereby affirm myself to be physically sound and suffering from no condition, aliment, impairment, disease, or other illness that would prevent my participation in such activities, I declare that I have disclosed any and all medical history relevant to participation.
with Whitney R. Simpson
I offer ecumenical spiritual care services for individuals and groups who seek to explore God’s peace in their lives through the art of spiritual direction and yoga. I am a member of the Fellowship of United Methodist Spiritual Directors and Retreat Leaders, Yoga Alliance, and Spiritual Directors International and follow the guidelines for ethical conduct of these organizations (a copy of these guidelines is available for review). I am also a 500-hour certified yoga instructor, 200-hour registered yoga teacher, and received my professional certification in spiritual formation as a spiritual director and retreat leader through Garrett-Evangelical Theological Seminary and the United Methodist Church's Global Board of Higher Education and Ministry.
Payment
The fee for private professional services is $75 per one-hour sessions and $35 per half-hour sessions (paid at the time of the session with Venmo, cash, check, or invoiced to your organization). If financial assistance is needed, please contact Whitney directly to discuss alternate methods of payment or an available sliding scale. Consider your financial payment as support of this ministry, as your commitment extends beyond the hourly session, providing safe spaces for others to listen for God as well.
Time of Sessions and Changes
We both commit to begin and end our sessions on time, sessions are scheduled for 60 minutes. You will receive a calendar appointment for sessions. If you wish to change your appointment, please let me know at least 24 hours in advance by rescheduling. You may email me or leave a voicemail or text on my work mobile number at 615.200.7255. If I were to experience an emergency need in rescheduling, I will contact you directly as well.
Confidentiality
I will hold our conversations in strict confidence. Our time together is sacred. I will not reveal the content of our conversations unless I am required to do so by law or court order. On the other hand, you are free to share whatever you choose about our time with anyone. Spiritual direction has impacted my journey greatly and it is something I share about often and process with spiritual friends and mentors. However, I will not release information about our session without your permission, except under the following required circumstances:
1. when there is threat or risk of self harm (suicide), or harm to another person (homicide)
2. when there is “reasonable cause” to suspect abuse or neglect of a child, disabled or elderly person, from
anything reported in a direction session.
3. when I receive a subpoena issued from a judge or court.
4. when a directee waives privilege by bringing charges or filing a suit.
Supervision
As part of my professional practice I consult with other spiritual directors through spiritual direction supervision. Your identity will never be revealed during this time. If you have any questions or concerns about this practice, please let me know and I will be happy to talk about it with you.
Our Relationship
We are meeting together for a time of spiritual care in order to examine your spiritual life with God. These sessions are not meant to be a substitute for professional counseling. While there is some overlap, counseling primarily focuses on one’s relationship with others and the issues surrounding them or on a particular situation in which one is seeking resolution, while spiritual direction focuses on one’s relationship with God. Sometimes God brings issues to the surface that need to be worked through and require the help of professional therapy in addition to or in lieu of our time together. You also recognize that spiritual direction does not include financial, professional, relational or health care advice and any decisions or actions you take in that regard are done without the advice or recommendation of myself or the organizations of which I am affiliated. You understand that the modality of yoga is sometimes included in a private session. Yoga includes physical movements as well as an opportunity for relaxation, stress reduction and relief of muscular tension. As is the case with any physical activity, the risk of injury, even serious or disabling, is always present and cannot be entirely eliminated. If you experience any pain or discomfort, you are asked to listen to your body, discontinue the activity, and ask for assistance. In addition, you will make me aware of any medical conditions or physical limitations before our time together. If you are pregnant, become pregnant or are post-natal or post-surgical, you verify that you have your physician's approval to participate in any physical activity.
Consent for Yoga Participation
I hereby consent for myself and agree to assume all of the risks involved. I understand that Exploring Peace Ministries, LLC/Whitney R. Simpson DBA Bloom Yoga Studio does not provide medical insurance relative to accidents, injuries, and/or death as a result of program related activities or advice; and that I can not hold them responsible for any liability. I recognize that any form of physical activity is a potentially hazardous one, and that they involve a risk of possible injury or even death. I hereby affirm that I am voluntarily participating in these activities with the knowledge of the risk involved. I agree to expressly assume and accept any and all risks of injury and/or death. I hereby affirm myself to be physically sound and suffering from no condition, aliment, impairment, disease, or other illness that would prevent my participation in such activities, I declare that I have disclosed any and all medical history relevant to participation.
