Mental Fitness Coaching
Register Today!
CONTACT INFORMATION
Name
*
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
Format: (000) 000-0000.
What are you hoping to gain from this course?
Back
Next
EVENT INFORMATION
Sessions
Session will be scheduled after form submission and payment.
Online Link will be emailed to participants.
Liability Waiver
*
I understand that this coaching session does not take the place of therapy by a licensed professional. It is not designed to treat any mental illness I have. I release the Mental Fitness Academy and Ursula Kelly from any and all claims regarding the state or occurrence of mental health issues as a result of my participation in coaching. I further state that I am enrolling in the courses of my own free will. I understand there may be risks associated with my participation in this session, and I assume all risks of my participation in this course, whether known or unknown to me. I RELEASE, DISCHARGE, COVENANT NOT TO SUE, AND HOLD HARMLESS The Mental Fitness Academy and its officers, employees, agents, and affiliates from any and all liability, claims, damages, or costs as governed by the state laws of Nevada. This agreement must be completed, or the course enrollment will be denied.
Would you be interested in enrolling in future programs?
*
Yes
No
Maybe
Submit
Should be Empty: