CREATING MOMENTUM COACHING
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    Agreement, Release & Waiver of Liability for Self-Actualization Coaching

    By electronically initialing each section and signing this form at the end, I indicate I agree to the following:
    *If you are not 18 years old, you are not eligible to participate in this program.
    * If you are 18 years of age or older, please complete with the rest of this form prior to your first coaching session.  






    I understand that my signed agreement, and release & wiaver liability will be retained in my client personnel file. This document is binding upon me and my heirs, children, wards, personal representatives and anyone else entitled to act on my behalf.

    By electronically signing the form below, “I Accept” all of the terms initialed  by me above.
    By entering your name, you are electronically signing this form.

    Emergency Contact's Information:
    In the unlikely event that an emergency arises during our coaching sessions, whom may I contact to bring you emergency assistance?

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Copyright © 2014
  • Home
    • Contact Me
    • Office Hours
    • About Me
    • Store
  • Blog
  • Creating Resilience Groups
  • Endurance and Run Coach
    • Wall of Fame
    • Earn Your Shirt Program
  • Health & Performance Coach
    • Functional Nutrition Coach >
      • More Info: Creating Balance
    • Mental Fitness Coach
  • Diabetes Prevention
  • "Run-60" Training Plan
  • Testimonials
  • Coach Mentorship & Supervision
    • H&W Coach Mentorship & Supervision
    • Endurance Coach Mentorship & Supervision
  • Gift Certificates
  • Refer a Friend Program