Coach Client Sign Up Form

Coach Use Only - Use this form to sign up a client for your roster only. The client does not get a copy of this form, so you can type in any comments you want to for reference.

PLEASE READ THE TERMS AND CONDITIONS TO THE CLIENT AT THE BOTTOM OF THIS FORM, so they are aware of the commitment they are making.

If you have a person who is interested in coaching and you think a DIFFERENT coach would be good for them, do not fill out this form - Fill out the COACH REFERRAL FORM to have that person routed to the Growth Strategist.

Coach Name*

First NameLast Name

Coach Email*

example@example.com

Enter the information for the Individual or Team to be coached. If another person is PAYING for the coaching, we will gather their information in the Payor Information Section.

Is this Client an Individual or Team?

IndividualTeam

**For Team's - Our CRM only allows us to track a Team as a single contact so we will use the unique Team name you create here (i.e. Sue Smith Sales Team, could be their company name). Make sure the name is unique in case more Teams from the same company are onboarded (i.e. Sue Smith ISA Team).

If a Team, What is the Team Name?

Have you already conducted Expectations Call(s) with the Team Members or Individual?

YesNo

Team Member #1 or Individual Client Name

First NameLast Name

Team Member #1 or Individual Client Email

example@example.com

Team Member #1 or Individual Client Phone

Please enter a valid phone number.

Team Member #2 Name

First NameLast Name

Team Member #2 Email

example@example.com

Team Member #2 Phone Number

Please enter a valid phone number.

Team Member #3 Name

First NameLast Name

Team Member #3 Email

example@example.com

Team Member #3 Phone Number

Please enter a valid phone number.

Team Member #4 Name

First NameLast Name

Team Member #4 Email

example@example.com

Team Member #4 Phone Number

Please enter a valid phone number.

List Additional Team Members Names and Emails

Who will be paying for the client's coaching?*

The ClientSomeone Else

Payor Email - (Re-enter the Client's email address if they are paying for coaching) **Remember to email the Enrollment Form link from the bottom of this form to this email address (CC or ACH) *

example@example.com

If not the Client, Enter Payor's Name

First NameLast Name

If not the Client, Enter Payor's Phone Number

Please enter a valid phone number.

Contract Type*

Start Date of Coaching*

Date

1st Month Payment Amount (if different than recurring)

Recurring Payment Amount*

Recurring Payments Method for Enrollment Form Link*

Credit CardACH Debit Withdrawal

Additional Comments:

What is your current goal?

What is your biggest motivation to achieve that goal?

What do you feel may keep you from achieving that goal?

When you are successful in coaching, what looks different in your life and business 6 months from now? 12 months from now?

What is the benchmark you will be using to know coaching is working?

Do you currently have someone in your life that challenges you to grow?

GAINING CLARITY OF ISSUES is important to me:

UNDERSTANDING WHAT IS IMPORTANT/ WHAT MOTIVATES ME is important to me:

EXPLORING AND UNDERSTANDING WHAT IS HOLDING ME BACK is important to me:

GAINING AN INSIGHT INTO WHO I AM, MY STRENGTHS, CAPABILITES AND POTENTIAL is important to me:

BEING PROVIDED WITH ENCOURAGEMENT AND SUPPORT is important to me:

RECEIVING HELP TO DEFINE GOALS is important to me:

RECEIVING HELP TO IDENTIFY ACTION AND NEXT STEPS is important to me:

BEING CHALLENGED WITH DIFFICULT QUESTIONS is important to me:

BEING PROVIDED WITH HONEST AND DIRECT FEEDBACK is important to me:

BEING HELD ACCOUNTABLE FOR MY GOALS is important to me:

With regard to everything we have discussed today, is this something now you are committed to taking action on, in order to achieve different results moving forward?

Coaching package rates vary. Monthly coaching rate is determined upon initial agreed rate of enrollment.
Coaching – Client agrees to participate in the CORE Leaders, LLC, consisting of individual virtual sessions with a CORE Leaders, LLC Independent Contractor (“Coach”) at a frequency agreed upon by the Client and Coach. These sessions will be structured to best meet the needs of the Client in the aspect of their personal or professional growth that is mutually agreed upon. Coaching may vary as the Client’s needs change. The sessions will be set by the Client and the Coach for 2 hours of coaching per month.

The Client is responsible for creating and implementing their own physical, mental, and emotional well-being, decisions, choices, actions, and results. As such, the Client agrees that the Coach and CORE Leaders LLC, is not and will not be liable for any action or inaction, or for any direct or indirect result of any services provided by the Coach. Coaching and Training is not therapy and does not substitute for therapy. It is not to be used as a substitute for professional advice by legal, mental, medical, financial, or other qualified professionals and will seek independent professional guidance for such matters.

Term: Contract is set to an auto-renew month to month term. Clients coaching commitment will begin the start month indicated upon signup, billed monthly, in advance, on the 1st of every month. Clients can choose to cancel at any time by providing written notice of termination to coach@coreleaders.com five (5) business days before the next monthly billing date.

Procedure: Coaching and Training Session scheduling and communication medium (phone/video) will be mutually agreed upon by the Coach and the Client. The Client will initiate all scheduled Coaching and Training Sessions contacting the Coach using the agreed upon communication medium.

Confidentiality: This Coaching and Training relationship and all information (documented and verbal) that the Client shares with the Coach as part of this relationship, is bound to confidentiality by the ICF Code of Ethics, but is not considered a legally confidential relationship. The Coach agrees not to disclose any information pertaining to the Client without the Client’s written consent. The Coach will not disclose the Client’s name as a reference without the Client’s consent. Confidential information does not include information that: (a) was in the Coaches possession prior to its being furnished by the Client; (b) is generally known to the public or in the Client’s industry; (c) is obtained by the Coach from a third party, without breach of any obligation to the Client; (d) is independently developed by the Coach without use of or reference to the Client’s confidential information; or (e) that the Coach is required by law to disclose.

Indemnification Clause: The client represents and warrants that all information provided to the company is true, complete, and accurate. The client hereby acknowledges that the company shall not be held responsible or liable for any errors, omissions, or inaccuracies in such information. The client agrees to indemnify and hold the company, its officers, directors, employees, agents, and affiliates harmless from and against any and all claims, damages, liabilities, costs, and expenses (including reasonable attorney fees) arising out of or in connection with any breach of this representation and warranty.

Payment: The first (1st) payment is due in full on the first (1st) day of the start month indicated in this agreement and all subsequent payments will be due, in advance, on the 1st day of each month. If payment is not received within five (5) days of the due date, Coaching and Training Sessions will be suspended until payment is received.

If you select to pay via Credit Card - I authorize CORE Leaders, LLC. to charge my credit card for the initial monthly payment and authorize that additional payments will be charged to my credit card on a monthly basis thereafter. A processing fee of a maximum of 3.5% will be assessed on every payment and will be paid by the client.

If you select to pay via ACH - I authorize CORE Leaders, LLC. to collect the initial monthly payment by initiating an ACH automatic debit and authorize CORE Leaders, LLC. to initiate an ACH automatic debit on a monthly basis thereafter.

Missed session: It is the Client’s responsibility to notify the Coach two (2) days in advance of the scheduled Coaching and Training Sessions if a session is to be missed. The Coach will attempt, in good faith, to reschedule any missed sessions, however, is under no obligation to do so. If Client fails to timely notify their coach, the missed call will count towards the Client’s coaching services.

Hold: It is the Client’s responsibility to notify the Coach in writing ten (10) days prior to the 1st of the month to place the contract on HOLD. The Client will be charged a $200 HOLD Fee per month not to exceed 2 months per calendar year.

Additional Coach Availability: The Coach may also be available, at the Coaches sole discretion, for additional time per the Client’s request.

Questions: Contact us at coach@coreleaders.com

Coach Client Sign Up Form

Coach Information

Client Information - Team or Individual?

Payor Information

Contract Information

Optional Questions for Sign Up

CORE Leaders Coaching Enrollment Terms & Conditions