HEALTH COACHING RELEASE & WAIVER I understand and agree with the following statements:
I do hereby waive, release, and forever discharge my coach, Kimberly Jones MA, CSCS, USAW, ZHEALTH, Certified Functional Medicine Health Coach and the FMCA (Functional Medicine Coaching Academy), and its officers, agents, independent contractors, employees, representatives, executors, and all others from any and all responsibility or liability for injuries or damages resulting from my engagement in any activities, including, but not limited to dietary changes, exercise, stress management, arising out of my participation in any activities under such coaching.
I understand that my health coach is neither a psychological or medical professional. The goal of coaching is to create a supportive alliance in which I can attain my own stated goals.
I agree that using any or every part of this health coaching service is entirely at my own risk. Health coaching services are provided "as is," without warranty of any kind, either express or implied. I understand that I may be coached in fitness, nutrition, stress management, emotional resilience, life visioning, overall preventive health and health risk management. These services may be requested or rejected at my own free choice.
Health coaching services are not meant to be a substitute for counseling or treatment for mental health problems. Health coaching is an excellent way to gather individualized information by which my own decisions can be made.
I understand that my certified Functional Medicine health coach is not an agent or employee of FMCA.
I further acknowledge that I have either had a physical examination and have been given a physician's permission to participate or that I have decided to participate in physical activity and/or use of exercise equipment without the approval of my physician and do hereby assume all responsibility and risks of injury from such participation and activities.
No assumption of responsibility is made, or given, and the party requesting such advice agrees not to hold the health coach or FMCA responsible or liable in any form or fashion, for such actions taken of my own accord. The method and process by which this advice and direction are given is acknowledged to be different in many ways than a one-on-one clinical or psychological counseling process.
I have read and understood all the above, and accept the above agreement of release of liability and the terms of the agreement, release and waiver.
1. SERVICES: The parties agree to engage in a 3-month Coaching Program through (virtual calls, initial in person introductory assessments (visual, vestibular, sensory, pain, movement etc.), initial training demonstration and application sessions, and/or phone calls. Coach Jones will be available to Client by e-mail and voicemail in between scheduled meetings as defined by the Coach (email or text message). Coach may also be available for additional time, per Client’s request on a prorated basis rate of $90 for 45 minutes for additional assistance: reviewing documents, reading or writing reports, engaging in other Client related services outside of coaching hours). 2. SCHEDULE AND FEES: This coaching agreement is valid as of 09/07/2019. The fee is $90 per week totaling $360 per month for 3 months. Virtual meetings occur once a week for a length of 60 minutes each.
3. PROCEDURE: The time of the coaching meetings and/or location will be determined by Coach and Client based on a mutually agreed upon time. The coach will initiate all scheduled calls and will call the client for all scheduled meetings.
4. CONFIDENTIALITY: This coaching relationship, as well as all information (documented or verbal) that the Client shares with the Coach as part of this relationship, is confidential. However, please be aware that the Coach-Client relationship is not considered a legally confidential relationship (like the medical and legal professions) and thus communications are not subject to the protection of any legally recognized privilege. The Coach agrees not to disclose any information pertaining to the Client without the Client’s written consent. The Coach will not disclose the Client’s name as a reference without the Client’s consent.
5. CANCELLATION POLICY: Client agrees that it is the Client's responsibility to notify the Coach 12-24 hours in advance of the scheduled calls/meetings. Coach reserves the right to bill Client for a missed meeting. Coach will attempt in good faith to reschedule the missed meeting.
6. TERMINATION: Either the Client or the Coach may terminate this Agreement at any time with written notice. Client agrees to compensate the Coach for all coaching services rendered through and including the effective date of termination of the coaching relationship. 7. LIMITED LIABILITY: Except as expressly provided in this Agreement, the Coach makes no guarantees, representations or warranties of any kind or nature, express or implied with respect to the coaching services negotiated, agreed upon and rendered. In no event shall the Coach be liable to the Client for any indirect, consequential or special damages. Notwithstanding any damages that the Client may incur, the Coach’s entire liability under this Agreement, and the Client’s exclusive remedy, shall be limited to the amount actually paid by the Client to the Coach under this Agreement for all coaching services rendered through and including the termination date.
ENTIRE AGREEMENT: This document reflects the entire agreement between the Coach and the Client, and reflects a complete understanding of the parties with respect to the subject matter. This Agreement supersedes all prior written and oral representations. The Agreement may not be amended, altered or supplemented except in writing signed by both the Coach and the Client.
DISPUTE RESOLUTION: If a dispute arises out of this Agreement that cannot be resolved by mutual consent, the Client and Coach agree to attempt to mediate in good faith for up to 30 days after notice given. If the dispute is not so resolved, and in the event of legal action, the prevailing party shall be entitled to recover attorney’s fees and court costs from the other party.
SEVERABILITY: If any provision of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. If the Court finds that any provision of this Agreement is invalid or unenforceable, but that by limiting such provision it would become valid and enforceable, then such provision shall be deemed to be written, construed, and enforced as so limited.
WAIVER: The failure of either party to enforce any provision of this Agreement shall not be construed as a waiver or limitation of that party's right to subsequently enforce and compel strict compliance with every provision of this Agreement.
APPLICABLE LAW: This Agreement shall be governed and construed in accordance with the laws of the State of California, without giving effect to any conflicts of law provisions.
BINDING EFFECT: This Agreement shall be binding upon the parties hereto and their respective successors and permissible assigns. Please sign and return one copy of this Client Agreement prior to the first scheduled coaching meeting.
SOCIAL MEDIA PHOTO & VIDEO RELEASE WAIVER: You hereby grant Jones Strength permission to use your likeness in a photograph, video, or other digital media (“photo”) in any and all of its publications, including web-based publications, without payment or other consideration.
You understand and agree that all photos will become the property of Jones Strength and will not be returned.
You hereby irrevocably authorize Jones Strength to edit, alter, copy, exhibit, publish, or distribute these photos for any lawful purpose. In addition, you waive any right to inspect or approve the finished product wherein my likeness appears. Additionally, you waive any right to royalties or other compensation arising or related to the use of the photo.
You hereby hold harmless, release, and forever discharge Jones Strength from all claims, demands, and causes of action which you, your heirs, representatives, executors, administrators, or any other persons acting on your behalf or on behalf of your estate have or may have by reason of this authorization.
YOU HAVE READ AND UNDERSTAND THE ABOVE. YOU AFFIRM THAT YOU ARE AT LEAST 18 YEARS OF AGE, OR, IF YOU ARE UNDER 18 YEARS OF AGE, YOU HAVE OBTAINED THE REQUIRED CONSENT OF YOUR PARENTS/GUARDIANS AS EVIDENCED BY SUBMITTING THIS FORM.