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Sign up form for coaching services
Client's Full Name
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Client's Email Address
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Client's Phone Number
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Date of Birth
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Select Coaching Package
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Basic Package- 1 Weekly 30-minute Session
Standard Package- 1 Weekly Hourly Session
Premium Package- 2 Weekly Hourly Sessions
Preferred Communication Method
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Phone
Video Call
Why are you seeking coaching/mentor services at this time?
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Coaching Disclaimer and Waiver: Your Life coaching services are not a replacement for professional mental health care or medical care. They are not intended to diagnose, treat, or cure any mental health or medical conditions. Your coach is not acting as a mental health counselor or medical professional. You are fully responsible for your well-being during and after your coaching sessions, including your choices and decisions. Coaching Services is not a substitute for counseling, psychotherapy, psychoanalysis, mental health care, or substance abuse treatment. Please do not use it in place of any form of therapy. All comments and ideas offered by your coach are solely to aid you in achieving your defined goals. By agreeing to this waiver, you consent to your coach assisting you in achieving these goals. Professional Boundaries: If your coaching involves career or business topics, your coach is not promising specific outcomes like increased clientele, profitability, or business success. Your coach will protect your information as confidential unless you state otherwise in writing. Please note that confidentiality may be limited in cases of reported child or elder abuse or neglect, self-harm, or harm to others. Technology and Confidentiality: Please be aware that using technology like email, text, phone, Skype, and others is not always secure. By participating in coaching, you accept the risks to confidentiality when using these technologies. Liability Release: You hereby release, waive, acquit, and discharge your coach, and any agents, successors, assigns, personal representatives, executors, heirs, and employees from every claim, suit, action, demand, or right to compensation for damages arising out of acts or omissions by yourself or your coach. This includes damages resulting from the advice given by your coach or otherwise resulting from the coaching relationship. This agreement binds your heirs, executors, personal representatives, administrators, and assigns. Acknowledgement: By continuing with coaching, you acknowledge that you have read, understand, and agree to the terms outlined in this document. You further declare and represent that no promise, inducement, or agreement not expressed in this agreement has been made to you to sign this agreement. This agreement shall be binding upon my heirs, executors, personal representatives, successors, assigns, and agents.
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I understand and agree to all terms.
Emergency Contact Name/Phone Number
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By signing below, I hereby certify that I have read, understand, and agree to be legally bound by all terms of this agreement.
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