Duke Integrative Health Coach Professional Training (IHCPT) Program Certification Course Client Consent Form

Client Consent Form
Client's Name:*

First NameLast Name
Phone Number*

Area CodePhone Number
E-mail*
I (please fill in client's name):*
Waiver for participation: I hereby release and hold harmless myself, my child, and/or representatives of Attain Health Foundation, the Rock CF Foundation, and any associated sponsors. By signing this, I agree that I am engaging in this program of my own will, and under the guidance of my physician. I understand that I am responsible for medical coverage for myself and/or my child.

Requires Patient/GuardianSignature.
Date*

MonthDayYear
Signature*
Should be Empty: