Informed Consent Agreement
Coaching Credentials: Certified Professional Life Coach, ACC
Conduct: AUTONOMY is governed by the highest level of professional conduct and Code of Ethics set forth by the International Coach Federation. If at any time along the journey we discover concerns or needs that are outside my skills and abilities, I will refer you to someone who specialized in what meets your needs.
Confidentiality and Privacy: Information shared and discussed is considered confidential. This includes any documentation or other material items developed for and during your Coaching Agreement. EXCEPTION: Cases of harm to self and others, illegal activity, court orders, or subpoenas. This includes cases when a sponsor pays for services. Clients are required to sign a release of information when it is appropriate to share information with a 3rd party. Information will be discussed with the Client.
Coaching Process: Coaches help people like you grow faster, perform at higher levels, understand themselves more deeply, and live with greater purpose and fulfillment. In the same way that a personal trainer helps a pro athlete maximize performance, a personal coach can help you get the most out of life. I aim to do that with you!
Coaching appointments begin with you reporting on your progress and end with a clear set of action steps you choose to take in the week ahead. A coach isn’t there to give advice. Instead, powerful coaching questions stimulate you to examine the things in life that matter most to you for a positive transformation. A coach is a friend and confidant, your greatest supporter, and someone who knows you well enough to call out the best in you. Coaches don’t give solutions; they help you solve your own problems.
Scheduling: Your sessions are scheduled weekly and will last approximately 50 minutes. It is required that you call no later than 24 hours in advance to reschedule or cancel your session. Otherwise, AUTONOMY reserves the right to charge $25 for the time reserved. I offer a range of terms to meet your needs: 4 weeks; 3 months; 6 months. I also tailor programs to meet your specific needs. I believe flexibility is vital to support clients.
Life Coaching Agreement
⦁ Coaching is delivered during sessions by telephone, zoom, email, or if desired, in person within the Golden Triangle Area (SETX).
⦁ Scheduled sessions are scheduled Monday – Friday.
⦁ The coach will generally initiate the call in order to incur any related calls. Or, a zoom link will be emailed prior to the session. Typical sessions last approximately 50-minutes.
⦁ 30-minute sessions are also available.
⦁ Some E-mails are included with Coaching Packages (see investment section).
Termination of Coaching Sessions: 24-hour notice of meeting cancellation is required to avoid a fee of $25. For subsequent cancellations with less than 24-hour notice, the coach reserves the right to not grant credit for the session, due to opportunity loss. Either party may end the coaching relationship at any point, for any reason.
Coaching Investment: Coaching is a valuable investment in yourself to help you be your best self. Immediately following are the investment fees.
Standard Coaching Package @ $360 per month
Offers you up to four hours of private coaching per month (once a week) with email access up to 2 times per week between sessions to keep me updated on progress.
Extended Coaching Package @ $960 for 3 months
Offers four hours of coaching per month for 3 months, with email access up to 2 times per week between sessions to keep me updated on progress.
Expanded Coaching Package @ $1800 for 6 months
Offers four hours of coaching per month for 6 months with email access up to 2 times per week between sessions to keep me updated on progress.
You may also book individual 50-minute coaching sessions @ $100 per session.
Thirty-minute coaching sessions are an option with limited availability @ $50 per session.
Payment Methods Accepted: Payments are made in advance. Payments can be placed online or over the phone. Credit card payments and e-check payments are accepted. (Note: Payment information is not stored for future reference). Only when coaching takes place in person, are paper checks accepted. All returned checks accompany a $35 return processing fee. We also accept cash payments.
II. TERMINATION OF THE AUTONOMY, LLC PERSONAL MINDSET COACHING PROGRAM
A. Autonomy, LLC may terminate your participation in the Autonomy Personal Mindset Coaching Program if you fail to make any payment that is due and owing within fourteen (14) calendar days from the date in which the payment is due. If Autonomy, LLC terminates your participation in the Autonomy Personal Mindset Coaching Program pursuant to this Section II (A), you agree you are liable for the full Autonomy Personal Mindset Coaching Program Fee.
B. Autonomy, LLC Coaching may terminate this Agreement upon the breach of any provision of this Agreement by Participant. If Autonomy, LLC Coaching terminates this Agreement pursuant to this Section II(B), you agree you are liable for the full Autonomy Personal Mindset Coaching Program Fee.
In the event that the Participant engages in any group coaching sessions, the Participant agrees not to violate any other Autonomy Personal Mindset Coaching Program participants’ privacy, personality, and publicity rights by using or disclosing their personal information. You understand and agree “personal information” means any information relating to an identified or identifiable natural person, including but not limited to, name, date of birth, gender, address, contact details, username, demographic information, photographs, likeness, and voice recordings.
IV. MEDICAL DISCLAIMER
You agree that Autonomy Personal Mindset Coaching is not comprised of licensed medical professionals and the information presented in the Autonomy Personal Mindset Coaching Program is for informational and educational purposes only and is not intended to diagnose, treat, cure, or prevent any disease. The information in the Autonomy Personal Mindset Coaching Program is in no way intended as medical advice, substance abuse counseling, psychological counseling, or as a substitute for medical or any other professional counseling. The information should be used in conjunction with the guidance and care of your physician. Consult your physician before beginning this program as you would any medical, dietary, or fitness program. You agree with your use of the information in the Autonomy Personal Mindset Coaching Program is at your own risk and that Autonomy Mindset Coaching does not guarantee results.
PLEASE READ THE FOLLOWING SECTION CAREFULLY. IT CONTAINS PROVISIONS THAT GOVERN HOW CLAIMS WE AND YOU HAVE AGAINST EACH OTHER ARE RESOLVED. SECTION V CONTAINS A BINDING ARBITRATION CLAUSE AND CLASS ACTION WAIVER THAT REQUIRES YOU TO SUBMIT CLAIMS YOU HAVE AGAINST US TO BINDING AND FINAL ARBITRATION AND LIMITS YOUR RIGHT TO SEEK RELIEF BY JURY TRIAL OR CLASS ACTION.
V. AGREEMENT TO ARBITRATE
This section applies to any dispute except it doesn’t include a dispute relating to claims for any injunctive or equitable relief regarding the enforcement or validity of your or Autonomy Mindset Coaching’s Intellectual Property Rights. The term “dispute” means any dispute, action, or another controversy between you and Autonomy Mindset Coaching concerning this Agreement, whether in contract, warranty, tort, statute, regulation, ordinance, or any other legal or equitable basis. “Dispute” will be given the broadest possible meaning allowable under law.
A. Notice of Dispute
In the event of a dispute, you or Autonomy Mindset Coaching must give the other a Notice of Dispute, which is a written statement that sets forth the name, address, and contact information of the party giving it, the facts giving rise to the dispute, and the relief requested. You must send any Notice of Dispute via email to firstname.lastname@example.org. Autonomy Mindset Coaching will send any Notice of Dispute to you by Mail to your address if we have it, or otherwise to your email address. You and Autonomy Mindset Coaching will attempt to resolve any dispute through informal negotiation within sixty (60) days from the date the Notice of Dispute is sent. After sixty (60) days, you or Autonomy Mindset Coaching may commence arbitration.
B. Binding Arbitration
If you and Autonomy Mindset Coaching don’t resolve any Dispute by informal negotiation, any other effort to resolve the dispute will be conducted exclusively by binding arbitration as described in this section. You are giving up the right to litigate (or participate in as a party or class member) all disputes in court before a judge or jury. The arbitration will be conducted in the United States, and judgment on the arbitration award may be entered into any court of competent jurisdiction. The award of the arbitrator will be final and binding upon the parties without appeal or review except as permitted by US law. Either party may seek any interim or preliminary injunctive relief from any court of competent jurisdiction, as necessary to protect the party’s rights or property pending the completion of arbitration. Any and all legal, accounting, and other costs, fees, and expenses incurred by the prevailing party shall be borne by the non-prevailing party.
C. Prohibition of Class and Representative Actions and Non-Individual Actions
You and Autonomy Mindset Coaching agree that either may bring claims against the other only on an individual basis and not as part of any purported class or representative action or proceeding unless both you and Autonomy Mindset Coaching agree otherwise. The arbitrator may not consolidate or join more than one person’s or party’s claims and may not preside over any form of a consolidated, representative, or class proceeding. Also, the arbitrator may award relief (including monetary, injunctive, and declaratory relief) only in favor of the individual party seeking relief and only to the extent necessary to provide relief necessitated by that party’s claim(s). Any relief awarded cannot affect other Autonomy Mindset Coaching customers.
Life Coaching Agreement
Hold Harmless: The Client is responsible for his/her own decisions and actions. The Client agrees to hold the Coach free from all liability for any advice or consultation not related to, directly or indirectly, coaching-related communications between the parties.
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The Client agrees to indemnify, defend, and hold harmless Sandra Whitehead, ACC, and AUTONOMY, LLC, and any employees from any and all liability or expenses of any nature whatsoever.
In the event that the Coach is unable to perform, in whole or in part, the investment will be refunded and the Coach will not be under any further obligation.
By digitally checking the box upon checkout, this is indicating your agreement to this ICA and certifies understanding of, and agreement with, the following:
I agree to utilize Sandra Whitehead, ACC, AUTONOMY, LLC, Coaching services with the full understanding that Sandra Whitehead, ACC, AUTONOMY, LLC, Coaching services, any employees or volunteers are in no way responsible or liable for my decisions, actions, and their related outcomes. I have read this client service agreement and agree to abide by its terms and conditions and acknowledge receipt of my own copy of this Agreement.
Sandra Whitehead, ACC/AUTONOMY, LLC requires the above client signature prior to commencing any coaching work. Please complete and then email a signed copy of this page to Sandra Whitehead, ACC/AUTONOMY, LLC @
If you have any questions, please call or email me immediately. It is my intention to help you reach your goals and achieve greater personal and professional success through Coaching.