AthLEADers Sports Leadership Consulting

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Coach Name: Billy Hemberger

Business Name: AthLEADers

Coaches Phone Number: 702-301-1187

Coaches Email: coachhemberger@gmail.com

Purpose of Coaching:

AthLEADers is a service provided to athletes who are looking to build their mental skills and character. The purpose of this waiver is to provide clarity amongst AthLEADers services and the client. Please read the details below about the sessions:

1) Each session will take place in a public facility and be 60-minutes long.

2) Sessions will be recorded for the purpose of reflection and to advance teachings.

3) The registration is valid for the duration of work amongst Coach Hemberger and the athlete.

4) Communication can be done through email, text or call.

Athlete Name *

Athlete Phone Number *

Athlete Date of Birth *

YYYY

Parent/Guardian Name *

Parent/Guardian Phone Number *

Emergency Contact Information: Name, Number, Relationship to client. *

Today's Date *

YYYY

Purpose of Coaching: I understand that coaching is a professional relationship designed to support the client in setting and achieving personal goals, improving life skills, and promoting overall well-being. I acknowledge that coaching is not therapy, counseling, or mental health treatment, and that Coach Hemberger is not operating as a licensed therapist or counselor. *

Yes

Required

Confidentiality: I understand that all information shared during coaching sessions is confidential, except in the following circumstances:

If there is reason to believe the teen is in danger of harming themselves or others.

If there is suspected abuse or neglect.

If required by law or court order.

Required

Parental Consent: I, the undersigned parent/legal guardian of the minor client, give my full consent for Coach Hemberger to provide coaching services to my child. I understand the nature of coaching and give permission for my child to participate.

Please explain how you would like to me handle the parent-athlete dynamic regarding our sessions: *

The athlete and parent/guardian would like to keep all conversations between Coach Hemberger and the athlete.

The athlete and parent/guardian would like to keep the parent/guardian involved throughout the sessions. This would include updated summaries after each session.

The athlete and parent/guardian will let Coach Hemberger know if they want updates but do not require them.

Required

What are you hoping to get out of these sessions? *

Improve my ability to handle pressure and expectations.

Work on self-confidence.

Emotional Stability.

Leadership

Other

Required

If you selected "Other" in the previous question. Please explain:

Acknowledgment and Consent:

I certify that I have read and understood this waiver and consent form. I consent to the terms listed above and authorize Coach Hemberger to provide coaching services to my child.

Payments can be made through cash, check, Venmo (@Billy-Hemberger), or Zelle (702-301-1187).

I understand that the 5-session package is a non-refundable booking. Any cancellation done 24-hours in advance can be rescheduled. Cancellations done less than 24-hours in advance will result in a lost session.

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