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The Loving And Effective Parent

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Last Name *

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Notes to Business (your address or any special notes about your order)

Item	Quantity	Total
Unscheduled One hour Phone Session		$85.00
Total: $85.00

Please read the following Release of Liability and check the box to indicate your agreement with and acceptance of this Release of Liability.

I acknowledge I have voluntarily requested the parent coaching services of James Shaver. I acknowledge I am completely responsible for all of my decisions and actions in regards to the advice and recommendations offered by this parent coaching service. I acknowledge my use of this parent coaching service is entirely at my own risk.

I understand parent coaching is not clinical counseling, psychotherapy or any other type of licensed counseling, nor is it a substitute for those types of services.

I, on behalf of myself, assigns, or any other legal representatives release, discharge, waive, and forever relinquish James Shaver from any claims or liability, known or unknown, arising our of or in any way connected with my participation in the parent coaching services.