Client Mutual Agreement Coaching AgreementThis contract is between (enter your first and last name), herein after referred to as "client" and Buky Orjia, Certified Life Coach, herein referred to as "Coach."* First Last Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Email* Best Phone Number to Reach You*Secondary Number (if applicable)Emergency Contact* First Last Emergency Contact Phone Number*Purpose of the Emergency Contact AcknowledgmentPurpose of Emergency Contact. If at any time during the coaching relationship, the Coach determines it is in the Client's best interest to be referred to a mental health professional, by initialing the box below you are providing your Coach with permission to contact your emergency contact. Client is encouraged to list a family member, friend, co-worker, or mental health professional they trust. Utmost confidentiality will be exercised by the Coach when contacting an Emergency Contact and minimal information will be shared. The primary information to be shared is in the Client's best interest for client to seek the assistance of a mental health professional. The Clients purpose for entering into a Life Coaching relationship with the Coach will not be provided to Clients emergency contact, unless it has been verified that the Emergency Contact listed, is Clients verified therapist or psychologist. INITIAL THAT YOU AGREE To the above Statement.*SuccessI am 100% responsible for co-creating with my Coach, including my own success and overcoming the challenges that hold me back from creating success. I agree to keep my end of the coaching agreement by fully participating during and between sessions, including exploration and assignments. INITIAL THAT YOU AGREE To the above Statement*CommunicationI agree to communicate any misunderstandings or failed expectations directly to the Coach at the time that they occur so that the coaching relationship doesn't impede my ability to achieve my goals. INITIAL THAT YOU AGREE To the above Statement*Attending SessionsI agree to be present and on time for all sessions. If I need to cancel a session, I agree to give at least 24 hours notice, unless otherwise agreed upon. I understand that the Coach cannot guarantee accommodation for last minute changes and I may forfeit the session. I also understand that if I am more than 10 minutes late for the session, the session may also be forfeited. INITIAL THAT YOU AGREE To the above Statement*Coaching Duration and FeesI agree to pay the coaching fees as specified in the Coaching Program Description below, in advance of sessions as noted, unless I have made previous arrangements for payments. Persistent late payments will result in termination of agreement. The duration of the Coaching Agreement is based on the number of sessions outlined in the Personal Coaching Program section. The number of sessions purchased may be shortened or extended beyond the initial agreement, provided Coach and Client have achieved desired outcome(s). INITIAL THAT YOU AGREE To the above StatementYour Coaching Program DescriptionPersonalized Coaching Program for:* First Last Sessions are to be scheduled weekly. Sessions will be conducted via phone or Skype. All sessions are paid in advance. Client must execute this agreement by the date indicated on the invoice and pay initial session fee indicated on the invoice. INITIAL THAT YOU AGREE To the above Statement*Important Notice Regarding CoachingBy signing this Agreement, Client acknowledges that coaching is not a form of or substitute for counseling, psychotherapy, mental health care or other medical or health care intervention of any kind. The Coach does not claim to be, licensed medical or mental health professional, and life coaching is not a licensed activity in the State of Florida. If Client is currently under the care of a mental health professional, it is Client’s responsibility to consult with that person regarding the advisability of working with a coach. If at any time Client feels the need for professional counseling, Client agrees to promptly seek the assistance of a licensed professional. In addition, Client understands that participating in coaching entails risks associated with a challenging program of personal development, including risks of mental or emotional upset as well as risks that may not be foreseeable at this time. By signing this Agreement and participating in coaching, Client freely and voluntarily assumes all such risks. Client further understands and acknowledges that desired or anticipated results may not be achieved, and Client takes full responsibility for Client’s results, personal health and well-being, and actions and decisions. The Coach MAKES NO GUARANTEE, REPRESENTATION OR WARRANTY AS TO THE RESULTS THAT CLIENT MAY ATTAIN THROUGH COACHING AND EXPLICITLY DISCLAIMS ANY WARRANTY OR GUARANTEE, EXPRESS OR IMPLIED, OF RESULTS. INITIAL THAT YOU AGREE To the above Statement*Signature*Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920PhoneThis field is for validation purposes and should be left unchanged.