Private Coaching Program- Client Agreement Form (SAMPLE)

*highlighted items are adjusted based on client and program

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Welcome to Inner Glow Coaching! During our time together, you will learn ways to help yourself achieve a healthier diet and lifestyle. Please read the following. If you have any questions, feel free to reach out.

This Agreement is made today (Day, Month, Year) between Gabriella Motter (Women’s Health Coach) and (Client Name) (Program Participant).

The Program in which you are about to enroll will include all of the following:

• Weekly 1-hour personal coaching sessions

• Access to "Exploring your Inner Glow Workbook" prior to our first meeting.

• Access to and work through together "Ignite your Inner Glow Manual" with videos and tutorials.

• Access to personal messaging service

• Receive a post-session recap email after every session with reminders and notes about what action items we discussed.

 

SCHEDULING

Each scheduled session will end one hour after it was scheduled to begin, please be on time for the scheduled sessions. If the Program Participant needs to cancel or reschedule the appointment, the Program Participant must do so at least 24 hours in advance, otherwise the Program Participant will forfeit that appointment and will not have an opportunity to reschedule it. Our program begins (Start Date) and continues for (Length of program).

 

PAYMENTS AND REFUNDS

The Program Participant understands that the cost of the Program is $ per month and is billed each month or a one-time fee of $. The Program Participant understands that the obligation to pay the full amount is a significant part of the motivation underlying the program. It is designed to enhance the likelihood that she will be motivated to complete and thereby gain the full benefit of the program.

The payment for the Program is not refundable.

 

DISCLAIMER OF HEALTH CARE RELATED SERVICES

The Coach encourages the Program Participant to visit their physician before beginning the Program,

and to continue to visit and be treated by their healthcare professionals, including, without limitation, physician, during the Program. The Program Participant understands that the Coach is not acting in the capacity of a doctor, licensed dietician-nutritionist, psychologist, or other licensed or registered professional. Gabriella Motter, Health Coach, is a Certified Women’s Health Coach, trained by the Integrative Women’s Health Institute is a Certified Strength and Conditioning Specialist (CSCS) certified by The National Strength and Conditioning Association (NSCA).

Accordingly, the Program Participant understands that the Coach is not providing health care, medical or dietician services and will not diagnose, treat, or cure in any manner whatsoever any disease, condition, or other physical or mental ailments of the human body.

The Program Participant has chosen to work with the Coach after considering the information provided regarding the Program given during the above mentioned free initial consultation and understands that the information received should not be seen as medical or nursing advice.

Moreover, the Program, and the information provided to the Program Participant during the Program

are certainly not meant to take the place of Program Participant seeing and/or consulting with their licensed health care professionals before, during, and after the Program.

 

PERSONAL RESPONSIBILITY AND RELEASE OF HEALTH CARE RELATED CLAIMS

The Program Participant acknowledges that the Program Participant takes full responsibility for the Program Participant’s life and wellbeing, and all decisions made before, during and after this Program. The Coach makes no warranty or representation about whether the Program is suitable or appropriate for the Program Participant, and there is no guarantee that the Program Participant will obtain any particular result. The Program Participant expressly assumes the risks of the Program, whether or not such risks were created or exacerbated by the Coach and whether or not such risks were known or unknown at the time of participation. To the fullest extent permitted by South Carolina law, the Program Participant releases the Coach, her heirs, executors, administrators, and assigns (collectively the Releasees) from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law or equity, which against the Releasees, the Program Participant ever had, now has or will have arising from the Program Participant’s past, present or future participation in the Program, or otherwise with respect to the Program, unless arising from the gross negligence of the Releasees.

 

CONFIDENTIALITY

The Program Participant acknowledges the Coach will keep all information exchanged during the

program sessions in strict confidence. Additionally, the Program Participant is aware that the Coach is prohibited from disclosing any protected healthcare information that may be disclosed to the Coach, except under written authorization by the Program Participant or in response to a duly authorized Court

order.

 

CHOICE OF LAW, ARBITRATION AND LIMITED REMEDIES

This agreement shall be construed according to the laws of the State of South Carolina. In the event that any provision of this Agreement is deemed unenforceable, the remaining portions of the Agreement shall be severed and remain in full force. In the event a dispute arises between the parties, the parties will submit to binding arbitration before the American Arbitration Association (Commercial Arbitration and Meditation Center for the Americas Meditation and Arbitration Rules). Any judgment on the award

rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. Such arbitration shall be conducted by a single arbitrator and shall take place in Charleston, South Carolina. The sole remedy that can be awarded to the Program Participant in the event that an award is granted in arbitration is the refund of the unused portion of the Program Fee. The total liability of the Coach and Program Participant for all claims of any kind arising out of this agreement or the Program, whether in contract, tort or otherwise, shall be limited to the unused portion of any Program Fee. Without limiting the generality of the foregoing, no award of consequential, indirect, incidental, punitive, or other damages or attorneys’ fees may be granted to the Program Participant or to the Coach in any such arbitration.

This agreement represents the entire agreement between the Coach and the Program Participant. It is entered into without reliance on any promise or representation, whether oral or written, other than those expressly contained herein and supersedes any other such promises or representations. This agreement may only be modified in writing, signed by both the Health Coach and the Program

Participant.

If the terms of this Agreement are acceptable, please sign the acceptance below. By doing so, the Program Participant acknowledges that: (1) she has received a copy of this letter agreement; (2) she has had an opportunity to discuss the contents with the Coach and, if desired, to have it reviewed by an attorney, and (3) the Program Participant understands, accepts, and agrees to abide by the terms hereof.

 

 

Health Coach name: Gabriella Motter ________________________ Date: ___________

Program Participant: Client Name ________________________ Date: ___________