Student Coaching Requirements

Student Coaching Requirements

This Student Coaching Requirements form documents coaching services, expectations, required information, and agreed operational terms between the parties identified below.

Student Information

Student Name:    Date of Birth:

Parent / Guardian (if applicable)

Relationship:    Phone:    Email:

Coach / Program Representative

Affiliated Organization:    Phone:    Email:

Program Description and Objectives

Describe the coaching scope, objectives, and expected outcomes. The coach will provide individualized instruction, goal setting, progress monitoring, and periodic reporting as described below.

Program Start Date:    Estimated End Date:

Schedule and Attendance

Location: In-person Virtual

Fees, Billing, and Payment Terms

The following fees are required for services; they may include per-session fees, package rates, or monthly billing as indicated.

Cancellation, Make-up, and Refund Policy

Sessions cancelled with less than 24 hours' notice may be forfeited or subject to a cancellation fee as described herein. Make-up sessions are offered at the coach's discretion and subject to availability. Refunds are limited to unused prepaid sessions and processed in accordance with program rules.

I acknowledge and accept the program's cancellation and refund policy:

Responsibilities and Conduct

Coach Responsibilities: The coach will provide services consistent with professional standards, maintain scheduled appointments, provide progress notes when applicable, and notify the student/guardian of any foreseeable changes.

Student / Guardian Responsibilities: The student and guardian will attend sessions punctually, complete assigned work, behave respectfully, and provide necessary information to facilitate services.

I agree to comply with the responsibilities above:

Health, Safety, and Emergency Authorization

Emergency Contact Name:    Phone:

In the event of an emergency, I authorize the coach or representative to seek medical attention for the student if the guardian cannot be reached. I understand I will be responsible for costs incurred.

Privacy, Recording, and Use of Materials

Confidentiality: The coach will treat information shared in sessions as confidential subject to legal exceptions (e.g., harm to self/others, court order). Progress notes may be maintained for professional purposes.

Recording Consent: Sessions will not be recorded unless expressly permitted in writing. I consent to session recording for educational or quality purposes:

Liability, Indemnification, and Termination

Liability: The coach and organization shall exercise reasonable care in the provision of services. The student/guardian releases the coach from liability for incidental injury except where caused by gross negligence or willful misconduct.

Indemnification: The student/guardian agrees to indemnify and hold harmless the coach and organization from third-party claims arising from the student’s actions during coaching sessions, except to the extent caused by the coach’s gross negligence or willful misconduct.

Termination: Either party may terminate services upon written notice; outstanding fees for services rendered prior to termination remain payable. The coach reserves the right to terminate services for cause, including violation of conduct expectations.

I acknowledge I have read, understand, and accept the terms contained in this Student Coaching Requirements form and agree to provide accurate information to the coach.

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