Catalyst Coaching 360, Inc.
You, the Client, (the “Client”) acknowledge and understand that practitioners at Catalyst Coaching 360, Inc., incorporated in the state of Colorado (the "Company," “We,” “Us,” or “Our”) are not Medical Doctors or mental health therapists and do not practice medicine as licensed physicians prescribing, diagnosing, or treating diseases of the human body and do not practice mental health therapy as licensed psychologists or counselors. The Client further acknowledges that the services provided by Us do not involve the diagnosing of disease or prescribing of medicine for treatment of disease.
The Client acknowledges and understands that Our services are designed to teach tools and provide guidance to make positive changes and live a healthy lifestyle. Our services include coaching from unlicensed providers.
Reaching optimal health requires sincere commitment, possible lifestyle changes, and a positive attitude. If you are not prepared to make lifestyle changes, Company is not the right approach for you. Since every human being is unique on a biochemical level, Company cannot guarantee any specific results.
If you suﬀer from a medical condition, you must consult with an appropriate healthcare provider. While health and wellness tools can provide a host of benefits to sustain a healthy lifestyle, it is not a substitute for your family physician or other appropriate healthcare provider.
Company practitioners are not trained nor licensed to diagnose or treat pathological conditions, illnesses, injuries, or diseases or prescribe medications.
If you are under the care of another healthcare provider, it is important that you alert them to your participation in Company’s activities. Our health and wellness services may be a beneficial adjunct to traditional medical care, but it is not a substitute. If you have any health concerns, medical conditions, or take any medications, you must alert Us before participating.
Notice to pregnant women: all female patients must alert Us if they know or suspect that they are pregnant, since some of the activities could present a risk to the pregnancy. You should also consult with your primary physician/obstetrician before participating in any Company activities.
During the course of your participation in Company activities, your coach may ask you to provide relevant personal details/information relating to your background, health, lifestyle, etc. (hereafter referred to as “Information”), including but not limited to:
- Full name, physical address, email address, phone number, date of birth, etc.
- Your health history, including injuries, surgeries, prescriptions, etc. This information will be gathered from you via in-person interviews, questionnaires, evaluations, intake documents, phone, email, mail, video conferences, etc., and used to help personalize your coaching experience and communication as well as to comply with all legal obligations.
We will take all reasonable steps to protect your Information from unauthorized access, use, or disclosure by using strong passwords, up-to-date software on all devices, and locking file cabinets for physical documents. We will keep your Information confidential and will not disclose your Information unless you have provided written authorization, or as required by law or regulation. If Company is asked to disclose your Information to another entity, such as your employer, we will only disclose aggregate information, not individually identifiable health information.
However, even the best security practices cannot guarantee that all stored data will be completely free from third-party interception or corruption. In accordance with Standards for Privacy of Individually Identifiable Health Information, your consent is required for Company to collect, use, and disclose your personal Information. By signing below, you acknowledge consent for Company to collect your Information.
RELEASE OF LIABILITY
I, THE CLIENT, ACKNOWLEDGE AND UNDERSTAND THAT I AM VOLUNTARILY PARTICIPATING IN THE SERVICES (HEREAFTER “ACTIVITIES”) PROVIDED BY COMPANY WITH KNOWLEDGE OF THE RISKS INVOLVED AND HEREBY AGREE TO ACCEPT AND ASSUME ANY AND ALL RISKS OF INJURY, DEATH CAUSED, OR PROPRTY DAMAGE BY THE NEGLIGENCE OF COMPANY, ITS OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, AFFILIATES, SHAREHOLDERS, SUCCESSORS, AND ASSIGNS ("COLLECTIVELY, "RELEASEES”).
I ACCEPT FULL RESPONSIBILITY FOR ANY PERSONAL INJURY WHICH MAY RESULT FROM MY PARTICIPATION IN ANY COMPANY ACTIVITY, AND HEREBY HOLD HARMLESS COMPANY FOR ANY PERSONAL INJURY SUSTAINED BY ME, INCLUDING DEATH, CAUSED BY THE NEGLIGENCE OF ANY COMPANY RELEASEES.
I HEREBY EXPRESSLY WAIVE AND RELEASE ANY AND ALL CLAIMS BASED IN NEGLIGENCE AGAINST COMPANY AND RELEASEES ON ACCOUNT OF INJURY OR DEATH ARISING OUT OF OR ATTRIBUTABLE TO MY PARTICIPATION IN THE ACTIVITIES.
NOTHING IN THIS RELEASE SHOULD BE CONSTRUED AS RELEASING, DISCHARGING, OR WAIVING ANY CLAIMS THE CLIENT MAY HAVE FOR RECKLESS OR INTENTIONAL ACTS ON THE PART OF ANY COMPANY RELEASEE.
This RELEASE OF LIABILITY (hereafter “Agreement”) constitutes the sole and entire agreement of Company and me, the Client, with respect to the subject matter contained herein and supersedes all prior and contemporaneous understandings, agreements, representations, and warranties, both written and oral, with respect to such subject matter. If any term or provision of this Agreement is invalid, illegal, or unenforceable in any jurisdiction, such invalidity, illegality, or unenforceability shall not affect any other term or provision of this Agreement or invalidate or render unenforceable such term or provision in any other jurisdiction. This Agreement is binding on and shall inure to the benefit of the Company and me, the Client, and our respective successors and assigns.
Entire Agreement: This Agreement constitutes the entire agreement between the Parties and supersedes all prior agreements, communications, and writings, whether written or oral, between the Parties. The terms and conditions of this Agreement may only be amended by mutual written agreement of the Parties. No other modification, amendment or addition to this Agreement will be valid or enforceable unless in writing and signed by the Parties.
Headings: The headings in this Agreement are for convenience of reference only, and under no circumstances should they be construed as being a substantive part of this Agreement nor shall they limit or otherwise affect the meaning thereof.
Severability: If any provision of this Agreement is held invalid or unenforceable the remaining provisions and paragraphs shall continue in full force and effect and shall be binding on the Parties.
No Assignment: You shall not assign any rights, or delegate or subcontract any obligations, under this Agreement without Our prior written consent. Any assignment in violation of the above shall be deemed null and void. We may freely assign Our rights and obligations under this Agreement at any time. Subject to the limits on assignment stated above, this Agreement will inure to the benefit of, be binding on, and be enforceable against each of the Parties and their respective successors and assigns.
No Waiver: The waiver by either Party of a breach or violation of any provision in this Agreement shall not operate or be construed as a waiver of any subsequent breach or default of a similar nature, or as a waiver of any such provisions, rights, or privileges. Failure to insist upon full performance of the obligation or failure to exercise rights under this Agreement shall not constitute a waiver as to future defaults or exercise of rights.
Governing Law: This Agreement shall be governed, construed, and enforced in accordance with the substantive laws of the State of Colorado without regard to its choice of law provisions.
Arbitration: Any dispute, claim, or controversy arising out of or relating to this Agreement or the breach, termination, enforcement, interpretation or validity thereof, including the determination of the scope or applicability of this Agreement to arbitrate, shall be determined by arbitration in Colorado, before one (1) arbitrator. The arbitration shall be administered by AHLA Alternative Dispute Resolution Service Rules of Procedure for Arbitration, in Larimer County, Colorado.
Judgment on the award may be entered in any court having jurisdiction. This provision shall not preclude either Party from seeking provisional remedies in aid of arbitration from a court of appropriate jurisdiction. The arbitrator may, in the award, allocate all or part of the costs of the arbitration, including the fees of the arbitrator. You agree to submit any claims arising out of this Agreement to binding arbitration, and this dispute resolution provision constitutes a waiver of Your right to a jury trial. HOWEVER, prior to the Parties initiating Arbitration the Parties agree to attempt mediation of the dispute with a mutually agreeable trained mediator in Larimer County, Colorado. “Trained mediator” means a professional with actual training and experience in the field of Mediation and/or dispute resolution.
I ACKNOWLEDGE THAT I HAVE BEEN GIVEN THE OPPORTUNITY TO BARGAIN WITH RESPECT TO MY RIGHTS UNDER THIS CONTRACT. BY SIGNING, I ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND ALL OF THE TERMS OF THIS AGREEMENT AND THAT I AM VOLUNTARILY GIVING UP SUBSTANTIAL LEGAL RIGHTS, INCLUDING THE RIGHT TO SUE COMAPNY OR ITS RELEASEES.
© 2012 USCW. All rights reserved.