{YOUR BUSINESS NAME} COACHING
Participant Agreement

I, ______, agree that I am contracting with Your Name (Your Business) to participate in the full 6-month Your coaching program name.

I agree to pay Your Namethe sum of $______for the following program:

6-month Core-Level Coaching Program

This coaching program will provide the following services:

• Private One-on-One Coaching for a total of 12 sessions of support

• Sessions will occur twice monthly for a total of 6 months

• Email support for specific questions or issues as needed

Terms of Payment:

$_____ deposit will be made on ______, 2012

$______remaining balance will be paid as funds are available.

Pay through PayPal.com using this address: Your PayPal address/or other form of payment

OR go to: Your link to pay by credit card.

I understand that to get the full value from this investment that I need to do the work. Your Name cannot do it for me, she can only open the door for me to step through. I understand that this process requires me to look at myself clearly and courageously, to enter the process wholeheartedly, and to take action consistently over time. If I cannot count on myself to do that at least 80% of the time, I will not enter this agreement.

I understand that Your Name’s part is to:

  • show up on time and fully present for all calls
  • send worksheets and class materials in a timely fashion
  • support me in choosing actions that anchor my new beliefs and experiences with money and client attraction
  • share her observations about any unconscious patterns I may not see
  • treat me with compassion and understanding while not accepting excuses or less than my best
  • speak up if she sees my actions are not aligned with my intentions

I understand my part is to:

  • schedule all sessions in a timely manner
  • clear time daily and weekly to do the assigned work
  • ask for what I need as soon as I am aware of it, in order to have these sessions be a success
  • make payments in a timely manner

I understand that: Your Name does not dispense medical or psychological advice and or prescribe the use of any technique as a form for treatment of physical, medical or emotional problems. The intent of the Coach, Your Name is to offer information of a general nature to help you in your quest for personal growth and business skills. In the event you use any information offered to you for yourself, your family, friends or clients, which is your constitutional right, Jeannette Koczela, volunteers, and individuals or employees associated with Empowered Spirit Coaching assume no responsibility for your actions.

I understand that: every effort has been made to accurately represent our program and its potential. The testimonials and examples used are not intended to represent or guarantee that anyone will achieve the same or similar results. Each individual's success depends on his or her background, dedication, desire and motivation. As with any business endeavor, there is an inherent risk of loss of capital and there is no guarantee that you will earn any money.

I understand that: I am committing to paying in full, as this is a comprehensive program I am enrolling in. This is a morally and legally binding agreement. Payments are non-refundable.

A $25 late fee will be charged for payment not received, or unable to be processed, by each installment due date. I understand that if, for any reason, I do not make a full and complete payment, then I will no longer be eligible for this payment plan and I will be fully responsible for the total sum plus 10% interest, immediately.

I understand that I will be responsible for any legal fees which might arise and any expenses which may be incurred by Your Businessin efforts to obtain full payment, if I fail to meet the conditions of this Agreement.

I understand the above agreement and acknowledge that I have received information and have had the opportunity to ask and explore any questions. I agree to the above terms.

Name Date

Address

City/State

Zip code Country

Email Phone

ACCEPT-Signature ______

NOTE: You can “sign” this form electronically by typing your name in the “Accept” space and returning it to Your Nameby electronic mail at Your Email address.