1:1 Coaching Session with Renae

Name*

First NameLast Name

Email*

example@example.com

Phone Number*

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*By providing your email address, you are consenting to receiving emails from Renae Matt and The Routine Advantage Podcast. You will have the option to unsubscribe at any time.

Address*

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What is your occupation?*

To help me prepare for our virtual session, please tell me a little bit about yourself:*

What is your NUMBER ONE GOAL for our session? What are you hoping to accomplish?*

Please note that our coaching session will be recorded so that Renae can send you a copy of the call to reference back to. If you are willing, we would love to air your session (or a portion of your session) on the podcast so that others can learn from our strategy session and discussion. Discretion will be used when airing any portion of a coaching session.

IMPORTANT: Your session will NOT be aired on the podcast unless you give permission below.

I will have a microphone (or wired earbuds/headset with built-in microphone) for the virtual coaching session:*

YesNo

I understand that Renae Matt and The Routine Advantage Podcast are not liable for anything I say during this coaching session:*

YesNo

I, undersigned, agree with the following statement:*

I consent to the recording of my session.

I, undersigned, agree with the selected following statement (select one):*

[PREFERRED] I grant Renae Matt and The Routine Advantage Podcast the right to use the recording, or any portion of it thereof, for any purpose(s) and promotion(s) and consent to my full name being used.I grant Renae Matt and The Routine Advantage Podcast the right to use the recording, or any portion of it thereof, for any purpose(s) and promotion(s) and request that only my first name be used.I grant Renae Matt and The Routine Advantage Podcast the right to use the recording, or any portion of it thereof, for any purpose(s) and promotion(s) and request that my name remains anonymous.I do NOT grant Renae Matt and The Routine Advantage Podcast the right to use the recording, or any portion of it thereof, for any purpose(s) and promotion(s) and request that the recording remains private.

Please provide a photo of yourself (optional):

I, undersigned, hereby grant to Renae Matt, The Routine Advantage Podcast, and its team, affiliates, agents, successors, and assigns the right and permission to record, use, publish, or otherwise distribute any audio or video interview or session with me based on my answer(s) provided above. Such right and permission includes, but is not limited to my name, recorded audio or video, photograph or likeness, biographical information, handouts or any material based upon or derived. This grant of permission does not include the release of confidential information. For purposes of the paragraph, "confidential information" is defined as home address, email address, telephone numbers or date of birth. I also understand that this session is to speak with Renae Matt and to brainstorm together regarding my concerns on task management, organization and/or to strategize routines. I understand that Renae Matt is not a licensed therapist, mental health professional, or otherwise, and that there are no guarantees or promises made for the outcome of this session.

Today's date:*

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