Healthy Coach Kate

1-on-1 Waiver 3 Months

This agreement between Kathleen M. Kirsh (RN and Certified Life Coach, Find Your Healthy  Way with Coach Kate, LLC) and  takes effect

Both parties agree to this agreement for the participation in Kate’s Lose the Weight Once and  for all heretofore referred to as “the course”. 

Course Participant Services Agreement 

This Client/Course Service Agreement (“Agreement”) is entered into and effective as of the  date of electronic acceptance, by and between (“Client”) and Kathleen M. Kirsh  RN, Certified Life Coach, Find Your Healthy Way with Coach Kate, LLC (“Company”). The  Client’s acceptance of the Agreement is signified by clicking the check box below the text of  this Agreement which says “I accept these terms and agree to pay all related invoices as they  fall due” and then clicking “Continue”. 

In consideration of Client retaining Company to perform specific type of coaching services as  part of the name of the program, it is agreed as follows: 

  1. Scope of Services 

Client hereby retains Company to provide sessions of individual life coaching within the context  of a 3 month individual course. 

(“Services”). The Services shall be delivered via e-mail/online video calls/online chats and shall  include the following: 

  • Individual coaching calls via “Zoom” or similar video communication platforms and online  coaching via the “Slack” app or a similar web-based application. 
  • Reasonable Slack text support within 72 hours of posting questions. 
  • Video lessons and worksheets via website. 

It is the Client’s responsibility to complete the lessons and to come to the scheduled coaching  sessions. 

  1. Compensation  

(a) Compensation: In consideration for the Services provided by Company to Client, Client  agrees to pay Company a one-time fee of $1,375.  

The fee shall be payable as follows: 

$1,375 paid today. All payments are non-refundable. 

(a) All payments shall be made via credit card on file. Company’s obligation to render services  hereunder is conditioned upon Client’s payment of said fee on a timely basis. (b) Tools to be Provided by Client: Client agrees to provide all tools, information, and  documentation that may be required by Company to effectively perform said  responsibilities in connection with the performance of services. 

(c) Additional Client Duties: Client’s active participation in the creative coaching process is vital  to the success of the program. Client is expected to complete any assignments to the best  of Client’s abilities. Client agrees to communicate honestly and respectfully throughout the  coaching process. 

  1. Term 

The term of this original Agreement shall be for a minimum of (3) months from date of  electronic acceptance of contract, or through the end of the course period whichever comes  later. NOTE: all course materials must be downloaded, if desired, no later than 30 days after  the completion of this 3 month course.

  1. Cancellation 

All payments are non-refundable. 

Client may terminate this agreement and discontinue use of the services at any time providing  notice in writing, but no portion of payments will be returned. Client remains responsible for  any outstanding payments in spite of termination to complete the full fee amount of $1,375.  Company may cancel this Agreement at any time for any reason by providing written notice to  the Client. In the event that Company cancels this Agreement, Company will provide a  prorated refund of the fees collected for which services have not been rendered minus any  approved, unpaid expenses incurred on Client’s behalf. 

  1. Confidentiality 

(a) During the term of this agreement Company takes reasonable steps to maintain the  confidentiality of your information. However, there is an inherent risk in all forms of  electronic communication, and communications between you and Company may be  unlawfully intercepted by third parties not under our control. Company does not guarantee  the security of any information transmitted via the internet, telephone, fax, or text message.  Any efforts you undertake to communicate with Company are done at your own risk.  Company may use recordings of sessions and other communications as desired.  

(b) The Client understands that the Company does not have control over 3rd party service  providers, namely Zoom, Slack, Wordpress, and Google Gmail and the Company will take  every measure to use the most secure platforms possible using the most updated security  measures available with these 3rd party platforms and Company is not responsible for any  breaches on the part of these 3rd parties. 

  1. No Guarantees 

Company cannot guarantee the outcome of the Services and Company’s comments about the  outcome are expressions of opinion only. Company makes no guarantees other than that the  services described in paragraph 1(a) shall be provided to Client in accordance with the terms of  this agreement. Client acknowledges that Company cannot guarantee any results for the  Services as such outcomes are based on subjective factors that cannot be controlled by  Company. Client understands that a life coach is not a licensed medical or mental health  professional, and coaching services are not a substitute for medical or psychological treatment  or advice. Company or Kathleen M. Kirsh cannot and will not diagnose illnesses as part of this  coaching relationship. Client understands that Company or Kathleen M. Kirsh is not a  Registered Dietician and will not be providing nutritional advice or dietary guidelines.  

  1. Ownership of Intellectual Property Rights 

All material and information provided by the Company as part of the Service is proprietary and  comprises intellectual property owned solely by Company. Company maintains exclusive  worldwide right, title, interest, ownership, and all subsidiary rights, including all rights accruing  to Company under the United States Copyright Act, in and to all works of authorship and all  copyrights, patents, trade secrets, and any other intellectual property rights, business  concepts, plans and ideas, reports, manuals, visual aids, documentation, inventions,  processes, proposed products, services, techniques, marketing ideas, and commercial  strategies, that have been or will be created by Company(“the Work”), for use throughout the  world in perpetuity in any manner or media whether now known or hereafter invented. Client  does not have permission to use, produce, distribute or create derivative works based on the  Work.

  1. Effect of Headings  

The subject headings of the paragraphs and subparagraphs of this Agreement are included for  convenience only and shall not affect the construction or interpretation of any of its provisions. 

  1. Entire Agreement, Modification; Waiver 

This Agreement constitutes the entire agreement between the parties pertaining to the subject  matter contained in it and supersedes all prior and contemporaneous agreements,  representations, and understandings of the parties. No supplement , modification, or  amendment of this Agreement shall be deemed, or shall be binding unless executed in writing  by all the parties. No waiver of any of the provisions of this Agreement shall be deemed, or  shall constitute, a waiver of any other provision, whether or not similar, nor shall any waiver  constitute a continuing waiver. No waiver shall be binding unless executed in writing by the  party making the waiver. 

  1. Neutral Construction 

This agreement was prepared by Company. It is expressly understood and agreed that this  Agreement shall not be construed against Company merely because it was prepared by her;  rather each provision of this Agreement shall be construed in a manner which is fair to both  parties. 

  1. Counterparts 

This Agreement may be executed in one or more counterparts, each of which shall be deemed  an original, but all of which together shall constitute one and the same instrument. 

  1. Assignment 

This Agreement shall be binding on, and shall inure to the benefit of, the parties to it and their  respective heirs, legal representatives, successors, and assigns; provided however, that Client  may not assign of its rights under this Agreement, except to a wholly owned subsidiary  corporation of Client. No such assignment by Client to its wholly owned subsidiary shall relieve  Client of its obligations or duties under this Agreement. 

  1. Recovery of Litigation Expenses 

If any legal action or any arbitration or other proceeding is brought for the enforcement of this  Agreement, or because of an alleged dispute, breach, default, or misrepresentation, in  connection with any provision of this Agreement, the prevailing party shall be entitled to  recover reasonable attorney fees, expert fees, and other costs incurred to that action, or  proceeding, in addition to any other relief to which the prevailing party may be entitled.  

  1. Limitation of Liability  




  1. Jurisdiction of Disputes; Mediation 

Any disputes based on or arising out of this Agreement or its subject matter, whether based on  contract, tort or other legal theory, shall be heard and determined by a judge of the State of  Ohio, County of Medina. The parties acknowledge that disputes brought before the Court may  be referred to mediation before trial. Both parties agree to participate in mediation  proceedings if recommended by the court. 

  1. Notices  

All notices, requests, demands and other communications under this agreement shall be in  writing and shall be deemed to have been duly given on the date of service if served personally  on the party to whom notice is to be given, or on the day of electronic mailing to the email  addresses below: 

To Client at: email address on file with Company (to be the email address the Client uses when booking this service) 

To Company at: 

Any party may change its address for purposes of this paragraph by giving the other parties  written notice of the new address in the manner set forth above. 

  1. Governing Law; Venue 

This Agreement shall be construed in accordance with, and governed by, the laws of the State  of Ohio. The exclusive venue for any action, arbitration, or other proceeding based on or  arising out of this Agreement shall be Ohio. 

  1. Severability 

If any term, provision, covenant, or condition of this Agreement is held by an arbitrator or court  of competent jurisdiction to be invalid, void, or unenforceable , the rest of the Agreement shall  remain in full force and effect and in no way be affected, impaired, or invalidated. 

  1. Signatures 

Acceptance of the Agreement shall be signified by the Company’s signature below and by the  Client’s acceptance of the Agreement, which is signified by signing in the box below the text of  this Agreement which says preceding it, below, “I accept these terms and agree to pay to all  related invoices as they fall due”.

Informed Consent for Life Coaching 

I acknowledge that Kathleen M. Kirsh, RN, Certified Life Coach, Find Your Healthy Way with  Coach Kate, LLC, its owners, agents, or employees (“Healthy Coach Kate”) will provide “life  coaching” or “health coaching” services (“Coaching” or “Coaching Services”).  

I further acknowledge that: 

  • The Coaching Services and their risks and benefits have been explained to me. The Coaching Services may not have the result that I expect, and I have been informed as to  other possible services that may provide me a benefit; 
  • Coaching is not an exact science, and I have not been given any guarantees about the result  of Coaching; 
  • I have had ample opportunity and time to discuss my concerns with Healthy Coach Kate or  my healthcare provider, and all of my questions have been answered to my satisfaction; I will not be provided any services of any kind relating to diagnosing and treating human  responses to actual or potential health problems; 
  • Healthy Coach Kate will not be practicing nursing as part of my Coaching care, though she  may educate me about health and wellness topics; 
  • The Coaching Services may be provided remotely, including by teleconference, phone,  email, fax. 
  • I will maintain a primary care provider who will attend to my routine and urgent health care  needs. 
  • As Healthy Coach Kate will not be providing medical care as a life coach, insurance  superbills will not be available for coaching services, though receipts may be requested in  writing to


Healthy Coach Kate may use all participant video in whatever manner desired, such as for  future promotional or educational material.  

All coaching calls will be recorded for use by Find Your Healthy Way with Coach Kate for  potential future use. 

Coaching is Not a Licensed Professional Service 

I acknowledge that, although the owner of Find Your Healthy Way with Coach Kate is a  Registered Nurse, the Coaching Services do not constitute the practice of nursing or any other  service for which a state licensure is required, including the practice of medicine, psychiatry,  social work, nutrition/dietician, or mental health counseling. Find Your Healthy Way with  Coach Kate’s Coaching Services are based upon its owner’s, agent’s, or employee’s  proficiency in and knowledge of how to help clients make decisions, set and reach goals, and  deal with problems.  

Nothing in this policy is intended to limit the ability of Find Your Healthy Way with Coach Kate  to employ appropriate and lawful techniques that its owners, agents, or employees are  educated and licensed to perform. Conversely, nothing in this policy is intended to expand the  scope of practice for any activity, treatment, or consultation for which Find Your Healthy Way  with Coach Kate, its owners, agents, or employees are licensed to perform. 

Informed Consent for Coaching Services

By signing below, I acknowledge that I understand this policy and hereby give my informed  consent to receive Find Your Healthy Way with Coach Kate’s Coaching Services. This consent  shall be governed by and construed in accordance with Ohio law. I agree to the above  cancellation policy and authorize Find Your Healthy Way with Coach Kate to charge my credit  card on file for any missed visits or visits cancelled outside of the 24 hour cancellation window.  I state my agreement to and understanding of all of the above. I accept these terms and agree  to pay all related invoices as they fall due. 

Credit Card Authorization  

I authorize Find Your Healthy Way with Coach Kate, LLC to charge the credit card on file for fees due. I agree to pay for services in accordance with the issuing bank cardholder  agreement. I understand that my card will be held on file and will be charged as stated above.  

A receipt for each payment will be emailed to you via our office, and the charge will appear on  your credit card statement a charge from “Square” or “Find Your Healthy Way with Coach Kate,  LLC”. You agree that no prior-notification will be provided unless the date or amount changes, in which case you will receive notice from us prior to the payment being collected. 

Leave this empty:

Signature arrow sign here

Signed by Coach Kate Kirsh
Signed On: June 21, 2022

Signature Certificate
Document name: 1-on-1 Waiver 3 Months
lock iconUnique Document ID: 007724da4cb17b4346a90b81012152cf352ca19e
June 21, 2022 11:26 am EDT1-on-1 Waiver 3 Months Uploaded by Coach Kate Kirsh - IP