Coaching Program Enrollment Form

COACHING PROGRAM ENROLLMENT FORM

This Coaching Program Enrollment Form authorizes enrollment in coaching services and sets forth the obligations of the enrolling party. Completion and signature below indicate agreement to the terms and policies contained herein and authorization for the program provider to invoice and communicate as described.

Student Information

Date of Birth:

Parent / Guardian Information (if student is a minor)

I certify the student is a minor and I am enrolling on their behalf:

Program Selection & Payment

Program Format (select all that apply): One-on-one Group Workshop Virtual

Program Start Date:

Payment Plan: One-time payment Installments

Scholarship / Discount Applied:

Billing Information

Emergency & Medical Information

I authorize the program staff to provide basic first aid and to seek emergency medical treatment if necessary:

Policies, Consent and Liability

Fees and Payment: Enrollment constitutes a fee obligation. All fees must be paid according to the payment plan selected. Late payments may incur interest or administrative charges. Failure to pay may result in suspension of services and collection action. By checking the acknowledgement box below you authorize the program to charge the billing method provided and accept responsibility for fees.

I acknowledge and agree to the Fees and Payment terms.

Cancellation and Refund: Cancellations must be submitted in writing. A portion of fees may be refundable prior to program commencement subject to an administrative withdrawal fee. Once services commence, refunds are limited and may be pro-rated; certain deposits and fees are non-refundable. Specific refund amounts and deadlines will be provided in the program invoice and are governed by provider policy.

I acknowledge and accept the Cancellation and Refund policy.

Confidentiality and Limits of Coaching: Coaching conversations are confidential between coach and client, except where disclosure is required by law, where there is a risk of harm to self or others, or where the client consents. Coaching is not therapy or medical treatment. Coaches do not provide diagnosis or clinical therapy unless separately licensed and contracted to do so.

I acknowledge and accept the Confidentiality and Limits of Coaching.

Liability Release and Assumption of Risk: Participation in coaching may involve exercises, discussions, or activities that carry inherent risks. By enrolling, the signing party assumes all risks of participation and releases the program provider, coaches, staff, and affiliates from liability for injury, loss or damage except where caused by gross negligence or willful misconduct.

I agree to the Liability Release and Assumption of Risk.

Photo/Video Release: Program activities may be photographed or recorded for promotion, education, or documentation. By acknowledging below you grant the provider non-exclusive rights to use images or recordings of the student for these purposes, unless you notify the provider in writing declining such release prior to the start date.

I consent to the Photo/Video Release.

Data Processing and Communications: The provider will collect and retain personal information necessary for enrollment, billing, scheduling, and program delivery. By checking the box below you consent to program-related communications by telephone, email, or text messages, and to the storage and limited use of your personal information in accordance with provider practices.

I consent to Data Processing and Communications.

Final Acknowledgment

By signing below I certify that the foregoing information is true and complete to the best of my knowledge, that I have read and accept the program policies and terms set forth above, and that I am authorized to enroll the student named in this form. I authorize charges as described and understand failure to meet payment obligations may result in suspension or termination of services.

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