Member Care Informed Consent Member Care Informed Consent HiddenUsername Name* First Last Please acknowledge or consent to each of the following by adding your initials.I acknowledge that I have received and read the Member Care Policies. I voluntarily agree to do Self Care. I agree to give and receive community member care in my place of service and to meet with a Member Care Provider periodically. I give consent to the Regional Director/Personnel Director to refer me to the Life and Ministry Coach for regular contact during my first year of service and in subsequent years as needed. I give consent to the Regional Director or Member Care Provider to consult with the Member Care Consultant for other professional services as needed. I agree to having a mental health assessment if I need to leave my place of service prematurely and/or if I resign due to a critical incident. I also agree to counseling if that is recommended. Signature of person giving consent*Date* MM slash DD slash YYYY