The BraveOne Individual Coaching Agreement
Participant Liability Release Form
Please review and fill out the form.
BraveOne Coaching is valuable, private, and confidential. I agree to treat each meeting with the upmost respect and care. I understand that it's in my best interest to join the call without other people in the room. Because of the subject matter, I understand that this is not an appropriate time for children or other adults to be present, even if I have headphones on. Having any other person present could breach my privacy and confidentiality. 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 my coaching meeting is in session. I will be on time. I will come to the call prepared with questions and challenges I may be experiencing.
I understand that any comments or discussions that occur within the call are strictly confidential.
I understand that the staff and coaches 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 individual coaching may pose to a third party.
- Any danger a participant in individual coaching may pose to herself.
I understand that I will receive a link to access my session up to 48 hours before the meeting.
Each coaching session will last 50 minutes. I agree that if I am sick or cannot make it to a meeting, I will let my Coach know. I understand that I will be charged the full cost of the session for cancellations made less than 24 before the appointment and there will be no refund or make-up session.
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 my BraveOne Coach 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 my BraveOne Coach. The Coach is 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 my BraveOne Coach 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, I understand that I may stop attending my individual coaching sessions at any time. If I choose to do so, I understand that my fees will not be refunded.
During the duration of my coaching sessions, I understand that I will be asked to write a few comments about my time with my BraveOne Coach 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 individual coaching. I understand that it is my responsibility to let the BraveOne Community staff know if I do NOT want my evaluation comments used from the closing evaluation. This DOES NOT include any and all comments made during the coaching sessions. 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 individual coaching experience. I agree that if the BraveOne Coach ever says or does something that upsets me or doesn’t feel right, I will bring it up either to my Coach or to the BraveOne staff. All comments can be emailed to email@example.com.
I understand that the BraveOne Community 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/support and/or coaching I receive.
I understand that I am responsible for my own results in connection with the individual coaching experience. I understand that if I choose not to implement things I’ve learned in my coaching sessions, 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 individual coaching experience as the process can sometimes be uncomfortable. Continuing through the coaching process can lead to personal insight and growth.
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 my individual coaching.
I further understand and acknowledge that BraveOne Coaching is not psychiatric treatment, and that no doctor-patient or therapist-client relationship is established by my participation.
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 individual coaching without reimbursement of fees.
RELEASE OF INFORMATION:
I authorize the BraveOne Community, its 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 coaching 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 individual coaching experience, either paid in advance or in installments. 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 agree that if I’ve chosen to pay for my program in installments, the successive amounts will be automatically charged to my credit card on file. I understand that I am responsible to pay for all individual coaching sessions in advance regardless of my attendance. I understand that BraveOne Coaching fees are non-refundable.
COPYRIGHT OF MATERIALS:
I understand that materials provided to me during individual coaching 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.
I understand that near the completion of my individual coaching sessions, I may elect to continue in my individual coaching experience by notifying my BraveOne Coach in advance and paying for more sessions by going to the link provided by my BraveOne Coach and making payment(s) before attending my next session.
STATEMENT OF UNDERSTANDING:
I understand that any coaching fees are non-refundable.
RELEASE OF LIABILITY:
By typing my name below, I agree that I am a voluntary participant in BraveOne Coaching. 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 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 BraveOne Coaching.
On this date, I entered into a coaching relationship with BraveOne Community Inc and its team of coaches. 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.
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