The BraveOne Community Empowerment Wheel Boot Camp Agreement
Please review and fill out the form.
Welcome to the Empowerment Wheel Boot Camp! We can’t wait for you to get started! Please review the following information carefully. We want you to be familiar with policies/procedures so that things can run smoothly. Please read this very carefully so that there are no misunderstandings later on. If you have any questions please email the BraveOne Team at firstname.lastname@example.org. We’ll be happy to assist you.
The BraveOne Team
The Empowerment Wheel Boot Camp is a valuable, private, and confidential group. I agree to treat each meeting with the upmost respect and care. I will not join the call with other people in the room. I will not join the call from a location where I don’t have complete privacy. I understand that this is not a time for children or other adults to be present, even if I have headphones on. Having any other person present is a breach of privacy and confidentiality. If this circumstance occurs, I understand that the BraveOne Team will ask me to immediately close my session and join when I have privacy. I will join from a quiet and confidential place where I can concentrate on connecting together. I will not eat, move around, or do anything else that could potentially be distracting when the Empowerment Wheel Boot Camp is in session. I will be on time. I will come to the call prepared with questions about the Empowerment Wheel and challenges I may be experiencing.
I understand that group members names and any comments or discussions that occur within the group are strictly confidential. By typing my name below I agree to maintain confidentially of all members of the group.
I understand that Dr. Sheri and the staff of the BraveOne Community may be considered mandated reporters; thus, required to report to the proper authorities any of the following:
- Any first or second-hand knowledge of physical or sexual abuse of a child, minor, or an adult with a disability.
- Any danger a participant in the Empowerment Wheel Boot Camp may pose to a third party.
- Any danger a participant in the Empowerment Wheel Boot Camp may pose to herself.
I understand that I will receive a link to access the group session each time before the meeting.
There will be 6 meetings, each meeting will last 90 minutes. I agree that if I am sick or going to miss a meeting, I will let the BraveOne Team know. I understand that there will be no makeup meetings.
I understand that the BraveOne Community office is based in the United States and is open Monday through Friday. There are no weekend hours. I understand that if I send them something via email on Thursday night or Friday, they will most likely respond on Monday.
I understand that I am responsible for the decisions I make about my work with the Empowerment Wheel Boot Camp. Dr. Sheri and the BraveOne Team are happy to share opinions, offer resources, or make referrals. However, it is up to me to decide which, if any, to act upon.
I understand that if I decide to take a recommendation Dr. Sheri or the BraveOne Team gives, it is my choice and I take full responsibility for it. If I decide to work with someone based on a referral, I understand that the workings of that relationship will be entirely separate from my relationship with the BraveOne Community, it’s Courses, it’s staff, and it’s BraveOne Community Coaches.
I understand that I may stop attending the Empowerment Wheel Boot Camp at any time. If I choose to do so, I understand that my fees will not be refunded.
At the end of the 6 weeks in the Empowerment Wheel Boot Camp, I understand that I will be asked to write a few comments about my time in the Empowerment Wheel Boot Camp as an evaluation. I understand that it helps the BraveOne Community staff to see what I liked about the process, what results I received overall, and anything else I would like to add. I understand that the BraveOne Community may use my comments in the form of a client testimonial to share with others who are thinking of participating in an Empowerment Wheel Boot Camp. I understand that it is my responsibility to let the BraveOne Community staff know if I do NOT want my comments used from the closing evaluation. This DOES NOT include any and all comments made during the Empowerment Wheel Boot Camp. Those will ALWAYS remain confidential and will never be shared by the BraveOne staff.
I understand that the BraveOne staff want me to be satisfied with my Empowerment Wheel Boot Camp experience. I agree that if Dr. Sheri or the BraveOne Team ever say or do something that upsets me or doesn’t feel right, I will bring it up either to Dr. Sheri or to the BraveOne staff. All comments can be emailed to email@example.com.
I understand that the Empowerment Wheel Boot Camp is open to all participants regardless of their faith orientation. Some elements of the teaching draw from references to God and from a Christian-based philosophy, which may influence the teaching/group support I receive in the Empowerment Wheel Boot Camp.
I understand that participants in the Empowerment Wheel Boot Camp come from all ranges of trauma experiences, varied beliefs, lifestyles, orientations, socioeconomic, age, and spiritual faith experiences. Healing comes as we curiously enter into understanding a person’s experience from a non-judgmental stance. It is requested that we refrain from trying to fix another person or impose beliefs that we deem may be best for that individual. The devastation that comes by way of existential trauma, relational trauma, socioeconomic trauma, spiritual/faith trauma has the ability to be processed and worked through within an environment of safety.
I understand that I am responsible for my own results in connection with the Empowerment Wheel Boot Camp experience. I understand that if I choose not to implement things I’ve learned in the Empowerment Wheel Boot Camp, I may not see the progress I’m hoping for.
I understand the maximum benefit will occur with consistent attendance and at times I may feel conflicted about my Empowerment Wheel Boot Camp experience as the process can sometimes be uncomfortable. Continuing through the Empowerment Wheel Boot Camp can lead to personal insight and growth.
I understand that the group is impacted by my presence and am committing to attend all 6 Empowerment Wheel Boot Camp sessions.
If I have been advised by my physician or psychiatrist to use medication of any kind, I agree to continue using my medications as prescribed during the course of this Empowerment Wheel Boot Camp.
I further understand and acknowledge that the Empowerment Wheel Boot Camp is not psychiatric treatment, and that no doctor-patient or therapist-client relationship is established by my participation in this Empowerment Wheel Boot Camp.
I agree to cooperate fully with the staff of the BraveOne Community, and I understand that failure to do so may result in removal from the Empowerment Wheel Boot Camp.
RELEASE OF INFORMATION:
I authorize the BraveOne Community, it’s coaches, supervisors, and BraveOne Team to release and disclose information to other coaches, supervisors, and BraveOne Team members within the BraveOne Community for the purpose of coordinating care.
NO MEDICAL ADVICE, MENTAL HEALTH COUNSELING, OR INSURANCE REIMBURSEMENT:
The BraveOne Community and its Coaches are not intended to provide mental health treatment, and does not constitute a client/therapist relationship. I understand that the BraveOne Community is a membership site and the Company, nor its employees, members, representatives, coaches, and agents do not provide diagnosis. I understand that the BraveOne Community does not provide any type of superbill or receipt for services. The BraveOne Community does not work with insurance companies and does not provide any type of paperwork for insurance reimbursement and as a result of this I understand that I may not be reimbursed by my insurance company and agree to take on the responsibility of payment for services rendered regardless.
I understand that I am responsible for the total cost of the Empowerment Wheel Boot Camp experience. I agree to notify the BraveOne staff if my payment information needs to be updated or adjusted in any way. In the event any method of payment of fees and/or expenses proves nonredeemable or non-transferable by a U.S. bank or financial institution, I agree to pay an insufficient funds fee of $35. I understand that I am responsible to pay for all Empowerment Wheel Boot Camp meetings in advance regardless of my attendance. I understand that Empowerment Wheel Boot Camp fees are non-refundable.
COPYRIGHT OF MATERIALS:
I understand that materials provided to me during the Empowerment Wheel Boot Camp are copyrighted. Under no circumstances can the copy in these documents be used or reproduced in whole or part without the express written permission of BraveOne Community, Inc. and Dr. Sheri Keffer. The absence of a copyright notice on any given page or material should NOT be construed as an absence of copyright. These copyrights have been successfully defended in the past, and it is the policy of the BraveOne Community and BraveOne Community, Inc. to aggressively defend all intellectual properties.
STATEMENT OF UNDERSTANDING:
I understand that any fees are non-refundable and that the Empowerment Wheel Boot Camp meetings will not be rescheduled if I cannot attend.
RELEASE OF LIABILITY:
By typing my name below, I agree that I am a voluntary participant in the Empowerment Wheel Boot Camp. I agree to release and discharge as well as agree to indemnify and hold harmless Dr. Sheri Keffer, BraveOne Community, Inc., Karene Dodson/Integral Solutions, all BraveOne Community Small Group Coaches, their officers, directors, employees, agents and subcontractors, against all actions, causes of actions, claims, demands, costs and expenses and liabilities of any nature whatsoever that I may suffer directly or indirectly during the course of or as a result of my participation in the Empowerment Wheel Boot Camp.
On this date, I entered into a relationship with BraveOne Community, Inc., Dr. Sheri Keffer, and the BraveOne Team. I have read and agree to the policies and procedures above. A copy of this document will be emailed to me at the address provided.
Copyright © 2021 Dr. Sheri Keffer. All Rights Reserved.