Name *

First Name

Last Name

Date

MM

DD

YYYY

• I understand that the coaching services I will be receiving from my Coach are not offered as a substitute for professional mental health care or medical care and are not intended to diagnose, treat or cure any mental health or medical conditions. I also understand that my Coach is not acting as a mental health counsellor or a medical professional. *

AGREE

• I understand that coaching is, at present, an unregulated industry and that my Coach is not licensed by any internationally recognized regulator. *

AGREE

• I understand and agree that I am fully responsible for my well-being during my coaching sessions, and subsequently, including my choices and decisions. *

AGREE

• I understand that all comments and ideas offered by my Coach are solely for the purpose of aiding me in achieving my defined goals. I have the ability to give my informed consent, and hereby give such consent to my coach to assist me in achieving such goals and aims. *

AGREE

• I understand that my Coach will protect my information as confidential unless I state otherwise in writing. If I report child, elder abuse or neglect or threaten to harm myself or someone else, I understand that necessary actions will be taken and my confidentiality agreement is limited in this capacity. *

AGREE

• I understand that the use of technology is not always secure and I accept the risks of confidentiality in the use of email, text, phone, Zoom and other technology. *

AGREE

• I understand that Coaching Sessions are private, therefore no recording is authorized. By signing this agreement I acknowledge that I have no explicit authorization nor implied consent to record any of my Coaching Sessions. *

AGREE

• I hereby release, waive, and henceforth discharge my Coach, any agents, successors, and employees from every claim, suit action, demand or right to compensation for damages I may claim to have or that I may have arising out of acts or omissions by myself or by my Coach as a result of the advice given by my Coach or otherwise resulting from the coaching relationship contemplated by this agreement. I further declare and represent that no promise, inducement or agreement not expressed in this agreement has been made to me to sign this agreement. This agreement shall bind my heirs, executors, personal representatives, successors, assigns, and agents. *

AGREE

• I understand that questions and communications unrelated to scheduling will be addressed at scheduled sessions only.

AGREE

• I acknowledge that I have received an electronic copy of this Agreement and the Terms of Service. *

AGREE