The BraveOne Community Small Groups Agreement
Participant Liability Release Form
Please review and fill out the form.
Welcome to the BraveOne Community Small Groups! We can't wait to connect you with your coach and small group gals. 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 BraveOne Small Groups are valuable, private, and confidential groups. I agree to treat each meeting with the upmost respect and care. I agree to have my camera on the entire time and understand that there are no exceptions. If I need to step away, I will leave my camera on while I'm gone. 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 Coach 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 make sure my face is well lit so I can be seen clearly by my Coach and group members. I will join each session with a good internet connection and use a good device that is fully charged so I can be seen and heard easily by my Coach and group members. I will not eat, move around, drive, be in a moving vehicle either by myself or with others, or do anything else that could potentially be distracting when the Small Group is in session. I will be on time. I will come to the call prepared with questions about Dr. Sheri’s most recent teaching 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 the staff of the BraveOne Community Small Groups may be considered mandated reporters; thus, required to report to the proper authorities any of the following:
- Any reasonable suspicion of physical or sexual abuse of a child, minor, elder, or an adult with a disability.
- When a participant communicates a threat of bodily injury to others.
- When a participant may be a threat to herself or has plans of suicide.
I understand that I will receive a link to access the group session up to 48 hours before the Small Group meeting.
There will be one 90 Minute, Small Group meeting per week for 12 weeks. I agree that if I am sick or going to miss a meeting, I will let my Small Group Coach know. I understand that meetings are not recorded and 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 my 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 Small Group. The Small Group 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 Small Group or Small Group 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, its Small Groups, its staff, and its BraveOne Community Coaches.
I understand that I may stop attending the Small Group at any time. If I choose to do so, I understand that my fees will not be refunded.
At the end of the 12 weeks in the BraveOne Small Group, I understand that I will be asked to write a few comments about my time in the Small Group 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 joining a Small Group. 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 Small Group. 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 Small Group 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 Small Groups 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 and/or coaching I receive in the Small Group.
I understand that participants in the BraveOne Small Groups 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 honest coach led, Small Group environment of safety.
I understand that I am responsible for my own results in connection with the BraveOne Small Group experience. I understand that if I choose not to implement things I’ve learned in the BraveOne Small Group, 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 Small Group Coaching experience as the process can sometimes be uncomfortable. Continuing through the Small Group process can lead to personal insight and growth.
I understand that the group is impacted by my presence and am committing to attend 12 consecutive Small Group 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 Small Group.
I further understand and acknowledge that the BraveOne Community Small Group is not psychiatric treatment, and that no doctor-patient or therapist-client relationship is established by my participation in this Small Group.
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 my Small Group.
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 12-week Small Group 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 two installments, the second amount will be automatically charged to my credit card on file 30 days after the first charge. I understand that I am responsible to pay for all Small Group meetings in advance regardless of my attendance. I understand that Small Group Coaching fees are non-refundable.
COPYRIGHT OF MATERIALS:
I understand that materials provided to me during Small Groups 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 Small Group meetings, I may elect to continue in my Small Group experience by notifying my BraveOne Coach in advance and registering for another 12-week session by going to the link provided and making payment(s) before the start of the next 12-week session. Click here to register for the next 12-week session.
STATEMENT OF UNDERSTANDING:
I understand that any coaching fees are non-refundable and that Small Group 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 BraveOne Community Small Groups. 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 BraveOne Community Small Groups.
On this date, I entered into a Small Group 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.
Have questions? Email firstname.lastname@example.org
Connect with me on social media!