Name *

First Name

Last Name

In what other ways can I support you through the course of this program? Check all that apply.

Email Check-Ins

A Community Forum with All Participants

A Small-Group Forum with 3-4 Participants

“Homework” Assignments

I Prefer to Listen + Observe

Other

Privacy + Confidentiality Agreement *

Sharing your experiences with a group can be vulnerable and we ask our community to commit to keeping our discussions both during our calls and in the community forum private and confidential.

By checking this box I agree to keep all group discussions both in the calls and in the community forum private and confidential.

By checking this box, I agree that if I violate this confidentiality I will be removed from the group without refund.

Recording Agreement *

In an effort to make this offering as accessible as possible, I will be providing participants with the recordings. These will be for participants of this group and this group only.

By checking this box yI agree to keep these recordings private and confidential and for my personal use only.

By checking this box, I agree that if I violate this confidentiality I will be removed from the group without refund.

Medical Waiver *

This is a group coaching program intended to help you improve your relationship with exercise; and is not a replacement for individualized medical or mental health care.

By checking this box I understand that this course is for educational purposes only and is not intended to diagnose, treat, or cure any physical or mental health condition.