EDSD: » 2020 Annual Declaration of Pastoral Care

Full Name *

Title: *

Church/Institution: *

City: *

I certify that I have read the Episcopal Diocese of San Diego’s “Sexual Abuse and Misconduct Prevention and Response Manual”, that I understand their contents, and that I agree to abide by the policies set forth in those materials. I have taken the required training for Safeguarding God’s People which is to be renewed every five years as well as the newly required sexual harassment training required by the state of California bi-annually. I DECLARE THAT IN THE PAST YEAR: *

I have not provided counseling for more than six sessions.

I have provided such care to an individual for more than six sessions, but after six sessions I have sought and obtained professional supervision for such care or have referred the individual to professional counseling.

I do not and will not charge a fee or accept a donation for such pastoral care performed within the scope and performance of my church employment.

I have performed pastoral counseling outside of the scope and performance of my church employment and I possess valid and appropriate professional credentials under the laws of the State of California, and I have attached hereto proof of professional liability insurance (other than through the Church Insurance Company), including coverage for Sexual Misconduct, in force at all times.

Date

Signature