Are you ready to work together? Coaching Questionnaire Name* First Last Mailing Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*How did you hear about my coaching practice?*Why were you guided to purchase a coaching package?*What’s holding you back from shining fully?*Based on your answer above - what do you think you need to work on in this area of your life?*What do you fear you REALLY need to look at (EEK!)?*Where else is this issue showing up in your life?*What’s the doubt/fear that keeps chattering in your head?*What would be an Oh-My-Goddess, out of this Universe result at the end of our time together?*What would be a realistic, fully satisfied result?*Consent* I have read and agree to the terms in the coaching contract.AMIE WADE – Emotional Resiliency Coach email@example.com / (928) 487-0964 COACHING ENROLLMENT AGREEMENT THIS AGREEMENT entered into on this day of acceptance to the terms is for the arrangement of transformation/spiritual coaching with Amie Wade – Emotional Resiliency Coach (“Company”) whose address is at 3900 N. Stockton Hill Rd., Suite B #227, Kingman, AZ 86409 and myself (“Client”) collectively, the “Parties.” Whereas, the Client is desirous of engaging Company’s services and/or programs for transformation/spiritual coaching, business education, consulting, and/or business-coaching; and whereas, the Company is willing to provide those services and/or programs on the terms provided herein; NOW THEREFORE, In consideration of the covenants and conditions contained herein, and other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the Parties agree as follows: (1) COMPANY’S SERVICES. Upon execution of this Agreement and receipt of full Fee from the Client, the Company agrees to render services related to transformation/spiritual coaching, education, seminar, consulting, and/or business-coaching as more specifically delineated in Exhibit “A” of this Agreement (the “Program”). The scope of services rendered by Company pursuant to this contract shall be solely limited to those contained therein. LIMITATIONS. To the extent that dates for events/seminars are provided for specifically in Exhibit “A”, dates are subject to change at Company’s sole discretion. Also, specific seminars/events may be substituted in lieu of those specifically listed in Exhibit “A” at Company’s sole discretion. In some cases, such substitutions may result in an addition of the value provided to Client; but not diminution of value provided to Client. (2) COMPENSATION. Client agrees to compensate Company: PAYMENT IN FULL prior to the beginning the coaching sessions. Client has 3 days (72 hours) from the date of purchase to request a refund. (3) PAYMENT TERMS. Parties agree that the services to be rendered are in the nature of personal transformation/spiritual/business consulting/education coaching program. Upon execution of this Agreement, Client shall be responsible for the full extent of the Fee. Company shall not be obligated to invoice Client for payments. Client’s acceptance of this agreement comprises Client’s authorization for all charges set forth in this Agreement, if any, on or around the dates set forth herein. Upon execution of this agreement, all payments towards the Fee shall be collectable on the dates set forth herein. (4) REFUNDS: If you choose to cancel your coaching program before the start of your third session, the rate for each attended session will be $125.00 and will be deducted from the coaching package amount paid and the remaining funds will be refunded. No refunds will be issued after the start of your third session or 30 days, whichever is sooner. (5) CHARGEBACKS AND PAYMENT SECURITY. To the extent that Client provides Company with Credit-Card(s) information for payment on Client’s account, Company shall be authorized to charge Client’s credit-card(s) for any unpaid charges on or around the dates set forth herein. If client uses a multiple-payment plan to make payments to Company, Company shall be authorized to make all charges on or around the time they are due and not require separate authorization in order to do so. Client shall not make any chargebacks to Company’s account or cancel the credit card that is provided as security without Company’s prior written consent. Client is responsible for any fees associated with recouping payment on chargebacks and any collection fees associated therewith. Client shall not change any of the credit card information provided to Company without notifying Company in advance. (6) NO RESALE OF SERVICES PERMITTED. Client agrees not to reproduce, duplicate, copy, sell, trade, resell or exploit for any commercial purposes, any portion of the Program (including course materials), use of the Program, or access to the Program. This agreement is not transferrable or assignable without the Company’s prior written consent. (7) NO TRANSFER OF INTELLECTUAL PROPERTY. Company’s copyrighted and original materials shall be provided to the Client for his/her individual use only and a single-user license. Client shall not be authorized to use any of Company’s intellectual property for Client’s business purposes. Client shall not be authorized to share, copy, distribute, or otherwise disseminate any materials received from Company electronically or otherwise without the prior written consent of the Company. All intellectual property, including Company’s copyrighted Program and/or course materials, shall remain the sole property of the Company. No license to sell or distribute Company’s materials is granted or implied. (8) LIMITATION OF LIABILITY. Client agrees to use Company’s services Client’s own risk and that Program is only an educational service being provided. Client releases Company, it officers, employers, directors, and related entities from any and all damages that may result from anything and everything. Client accepts any and all risks, foreseeable or non-foreseeable. Regardless, if Company is found to be liable, Company’s liability to Client or to any third party is limited to the lesser of (a) the total fees Client paid to Company, and (b) $1000. All claims against Company must be lodged with the entity having jurisdiction within 100-day of the date of the first claim or otherwise be forfeited forever. Client agrees that Company will not be held liable for any damages of any kind resulting or arising from including but not limited to; direct, indirect, incidental, special, negligent, consequential, or exemplary damages happening from the use or misuse of Company’s services or enrollment in the Program. (9) CLIENT RESPONSIBILITY. Client accepts and agrees that she/he is 100% responsible for her/his progress and results from the Program. Client accepts and agrees that she/he is the one vital element to the Program’s success and that Company cannot control Client and/or Client’s participation. Company makes no representations or guarantees verbally or in writing regarding performance of this Agreement other than those specifically enumerated herein. Client accepts that, because of the nature of company’s services and extent of clients’ participation the results experienced by clients significantly vary. (10) NO SUBSTITUTE FOR MEDICAL TREATMENT. Client agrees to be mindful of his/her own wellbeing during the Program and seek medical treatment (including, but not limited to psychotherapy), if needed. Company does not diagnose medical ailments; do not provide medical, therapy, or psychotherapy services; do not prescribe substances. Company is not responsible for any decisions made by Client as a result of the coaching, energetic healing and/or any consequences thereof. Coaching is a designed alliance between the Coach and Client to bring out the best in the client and to include clarifying values, brainstorming, identifying plans of action, developing systems and/or overcoming specific personal limitations, as well as pinpointing and aligning with business objectives. Coaching should NOT be confused with professional therapy or counseling for conditions in the clients personal or professional life. In the event that the Client feels the need for personal counseling or therapy, it is the responsibility of the Client to seek a licensed professional. I, hereby certify that I do not suffer from any physical or mental disability that might affect my participation in the coaching process. If I have any substance abuse problems or mental illness, I have consulted with my physician and/or other health care professional and have been advised that I may participate in the coaching process without risk. (11) CONFIDENTIALITY. Confidential Information includes, but is not limited to, information disclosed in connection with this Agreement, and shall not include information that: (a) is now or subsequently becomes generally available to the public; (b) the Company or Client can have rightfully in its possession prior to disclosure by the disclosing party; (c) the Company or Client rightfully obtains from a third party. Company agrees not to disclose, reveal, or make use of any Confidential Information learned of through its transactions with Client, during discussion with Client, the coaching session with Company, or otherwise, without the written consent of Client. Company shall keep the Confidential Information of the Client in strictest confidence and shall use its best efforts to safeguard the Client’s Confidential Information and to protect it against disclosure, misuse, espionage, loss, and theft. To the extent that Client participates in group-coaching programs or interacts with other clients, Client agrees information received by Client about other client’s business or personal matters shall be considered Confidential Information and not be disclosed with the prior written consent of the disclosing party. In addition, all parties including all employees for both Companies agree that Company will not disclose or communicate any "Confidential Information" to any person or entity. For purposes of the preceding sentence, "Confidential Information" means (but is not limited to) any information regarding Clients business methods, business policies, procedures, techniques, research or development projects or results, sales information of any kind, financial information of any kind, trade secrets or other knowledge possessed by Client which is not generally known by individuals outside of the Client or Company (including Clients employees, consultants, and advisors). Also, "Confidential Information" shall additionally include, but not be limited to, the following information of the Client: a) Customer lists or other customer information b) Information pertaining to products or services under development; c) Internal company reports of any kind; d) All marketing strategies for client; (12) NON-DISPARAGEMENT. In the event that a dispute arises between the Parties, the Parties agree and accept that the only venue for resolving such a dispute shall be in the venue set forth herein below. In the event of a dispute between the Parties, the parties agree that they neither will engage in any conduct or communications, public or private, designed to disparage the other. (13) INDEMNIFICATION. Client shall defend, indemnify, and hold harmless Company, Company’s officers, employers, employees, directors, related entities, trustees, affiliates, and successors from and against any and all liabilities and expense whatsoever - including without limitation, claims, damages, judgments, awards, settlements, investigations, costs, attorneys fees, and disbursements - which any of them may incur or become obligated to pay arising out of or resulting from the offering for sale, the sale, and/or use of the product(s), excluding, however, any such expenses and liabilities which may result from a breach of this Agreement or sole negligence or willful misconduct by Company, or any of its shareholders, trustees, affiliates or successors. Client shall defend Company in any legal actions, regulatory actions, or the like arising from or related to this Agreement. Client recognizes and agrees that all of the Company’s shareholders, trustees, affiliates and successors shall not be held personally responsible or liable for any actions or representations of the Company. (14) CONTROLLING AGREEMENT. In the event of any conflict between the provisions contained in this Contract and any marketing materials used by Company, Company’s representatives, or employees, the provisions in this Agreement shall be controlling. (15) CHOICE OF LAW/VENUE. This Agreement shall be governed by and construed in accordance with the laws of the State of Arizona without giving effect to any principles or conflicts of law. The parties hereto agree to submit any dispute or controversy arising out of or relating to this Agreement to arbitration in the state of Arizona, County of Mohave, U.S.A., pursuant to the rules of the American Arbitration Association [IF IN USA], which arbitration shall be binding upon the parties and their successors in interest. The prevailing party is entitled to be reimbursed for all reasonable legal fees from the non-prevailing party in order to enforce the provisions of this Agreement. (16) ENTIRE AGREEMENT. This Agreement constitutes the entire agreement between the parties pertaining to the subject matter hereof and supersedes all prior and contemporaneous agreements, negotiations, and understandings, oral or written. This Agreement may be modified only by an instrument in writing duly executed by both parties. (17) SURVIVABILITY. The ownership, non-circumvention, non-disparagement, proprietary rights, and confidentiality provisions, and any provisions relating to payment of sums owed set forth in this Agreement, and any other provisions that by their sense and context the parties intend to have survive, shall survive the termination of this Agreement for any reason. (18) SEVERABILITY. If any of the provisions contained in this Agreement, or any part of them, is hereafter construed to be invalid or unenforceable, the same shall not affect the remainder of such provision or any other provision contained herein, which shall be given full effect regardless of the invalid provision or part thereof. (19) OTHER TERMS. Upon execution of This Agreement by written signature or electronic acknowledgment, the Parties agree that any employees, associates, or assigns of the Parties are likewise bound by the terms of THIS AGREEMENT. EXECUTION: The Recitals set forth above are true and correct and are incorporated into and made a part of this Agreement. I have read and understand this agreement and I warrant that I have complete authority to enter into THIS AGREEMENT. A facsimile, electronic, or e-mailed copy of this Agreement, with a written signature or electronic acknowledgment, shall constitute a legal and binding instrument or by me submitting payment, scheduling and beginning my sessions as scheduled I am accepting these Agreement terms and execute into a binding agreement. EXHIBIT “A”: EMOTIONAL RESILIENCY COACHING PROGRAM Company shall provide the following services as part of enrollment in the Agreement. It is agreed and understood that this program is a personal transformation/spiritual development coaching program with Amie (Amelgia) Wade. Coaching Package Options: OPTION 1) 30 Day Package (Four (4) coaching sessions) - $350* OPTION 2) 90 Day Package (Twelve (12) coaching sessions) - $897* *Coaching sessions are scheduled weekly for the duration of 60 minutes per session. Coaching sessions may be conducted by phone; or by video; or in person (if applicable). OPTION 3) 90 Day Package (Six (6) coaching sessions) - $500 Two (2) sessions per 30-day period (bi-weekly) for the duration of 60 minutes per session. Coaching sessions may be conducted by phone; or by video; or in person (if applicable). Also included in this program is: • Additional Support: Client may email questions and/or voice recorded messages as needed between sessions (not to exceed 5 emails/messages per week) – limits may be adjusted at the coach’s discretion. Coach may check-in with the client in between sessions as well. • Email Recap: An email may be sent to the client within 48 hours of each session with a recap of the coaching session. It is, however, the responsibility of the client to take their own notes during each session. EXECUTION: The Recitals set forth above are true and correct and are incorporated into and made a part of this Agreement. I have read and understand this agreement and I warrant that I have complete authority to enter into THIS AGREEMENT. A facsimile, electronic, or e-mailed copy of this Agreement, with a written signature or electronic acknowledgment, shall constitute a legal and binding instrument or by me submitting payment, scheduling, and beginning my sessions as scheduled I am accepting these Agreement terms and execute into a binding agreement. Choose your desired coaching package:*30 Day Package (Four (4) coaching sessions)90 Day Package (Twelve (12) coaching sessions)90 Day Package (Six (6) coaching sessions; bi-weekly)Total $0.00 After hitting submit, you will be directed to PayPal, please click return to Merchant and acknowledge the coaching contract.