Nourish The Gift VIP 1:1 Coaching Experience Application
Please fill out the Nourish The Gift application to establish which Nourish The Gift transformation programs are right for you and to be considered for one of the group programs or VIP Coaching experience. As much as we want to help everyone, we want to be able to give our clients the ultimate transformational coaching VIP experience, and give them individual support and attention.

Only 5 VIP clients are accepted at a time. You will be notified if you are accepted into the Nourishing Best Body/LIFE VIP Coaching Experience for Busy Women. Thank you for your trust and application, I look forward to serving you.

Please indicate the program you wish to be a part of at the end of the form. There are no right or wrong answers, do your best to answer the questions completely and give us an inside glimpse of your life. Jennifer will read each of the applications personally, and decide what program will be the best fit. Jennifer pride's herself on her clients results and only takes a limited number of clients so that she can give them her excellence.

As soon as your form is received you will receive confirmation via email with further instructions.

What is your full name? Phone number? Email address?
Your answer
How did you hear about Jennifer Lewis and Nourish The Gift Health Coaching?
Your answer
Describe Your Health and Weight as it is now.
Current Weight, Energy Levels, Mood Swings. Are you sleeping? Any official diagnosis and medical concerns? Please describe how you feel on a daily basis.
Your answer
If you are accepted into the program, what are your top 3 goals you want to accomplish in the next 30, 60, 90 Days?
Your answer
What other major investments have you made into recovering your health? Also if you are in the middle of any other coaching programs, please indicate the program name(s) here, and how you feel additional support through Nourish The Gift's Personal Coaching Experience can serve you best?
Your answer
Who or what do you think are your biggest obstacles in reaching your current goals?
Your answer
How will your life be different if you are accepted into this program and your goals are met?
Imagine for a moment that you have released your weight and you no longer have to endure the dieting roller coaster, you have energy and vitality that last throughout the day, you have shed the unwanted weight, you have gained confidence and an empowered mind set that helps you transform all areas of your life. What gets to open up for you? How different will your life be? What do you get to experience (joy, freedom, abundance, love, connection, self love, confidence)?
Your answer
What is your ultimate vision for yourself and your life?
Your answer
If accepted into the program, will you be able to commit to the investment ($297 to $5997) without inordinate stress?
Your answer
Please describe why you are an excellent candidate for the Nourish The Gift's VIP Coaching Intensive?
Your answer
Would you prefer the VIP Individual Coaching Experience or the Group Experience? If participating in a group, what will you be able to contribute to the group and other members? If individual are you willing to show up and do the work and be somewhat of a self motivator and follow through with recommendations?
Your answer
What else should we know about you that we haven't already asked?
Your answer
Electronic Signature: Please put the /s/ and your name as an acknowledgement that you agree to the terms and services and mark the "I have read" button
Terms and services: As your Coach, I understand that my clients have busy schedules and I take pride in not keeping them waiting or keeping them longer than planned. Each session will end 50 minutes after it was scheduled to begin. Please be on time. If you are not able to make the scheduled time within 15 minutes of your scheduled time the session will be forfeited and no reschedule will be available. If the Client needs to cancel or reschedule the appointment, the Client must do so 24 hours in advance; otherwise, the Client will forfeit that appointment and will not have an opportunity to reschedule it. If you must reschedule please do so 24 hours in advance or appointment will be forfeited.This program expires if all sessions have not been completed within two months after the End Date specified. PAYMENTS AND REFUNDS The Client understands that they have 14 days to discontinue their coaching program and receive a full refund minus a $50.00 cancellation fee. In the event of the Client’s absence or withdrawal, for any reason whatsoever, the Client will remain responsible for the pro rata share of the program that has been delivered, plus a cancelation fee of $50.00. The Coach reserves the right to cancel the program within 14 days, if at any point she or he feels it is not advantageous for the coaching program to continue. If this happens, the Client is only responsible for the pro rata share of coaching services received. DISCLAIMERS : The Client understands that the role of the Health Coach is not to prescribe or assess micro- and macronutrient levels; provide health care, medical or nutrition therapy services; or to diagnose, treat or cure any disease, condition or other physical or mental ailment of the human body. Rather, the Coach is a mentor and guide who has been trained in holistic health coaching to help clients reach their own health goals by helping clients devise and implement positive, sustainable lifestyle changes. The Client understands that the Coach is not acting in the capacity of a doctor, licensed dietician-nutritionist, psychologist or other licensed or registered professional, and that any advice given by the Coach is not meant to take the place of advice by these professionals. If the Client is under the care of a health care professional or currently uses prescription medications, the Client should discuss any dietary changes or potential dietary supplements use with his or her doctor, and should not discontinue any prescription medications without first consulting his or her doctor. The Client has chosen to work with the Coach and understands that the information received should not be seen as medical or nursing advice and is not meant to take the place of seeing licensed health professionals. PERSONAL RESPONSIBILITY AND RELEASE OF HEALTH CARE RELATED CLAIMS The Client acknowledges that the Client takes full responsibility for the Client’s life and well-being, as well as the lives and well-being of the Client’s family and children (where applicable), and all decisions made during and after this program. The Client expressly assumes the risks of the Program, including the risks of trying new foods or supplements, and the risks inherent in making lifestyle changes. The Client releases the Coach from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in law or equity, which the Client ever had, now has or will have in the future against the Coach, arising from the Client’s past or future participation in, or otherwise with respect to, the Program, unless arising from the gross negligence of the Coach. CONFIDENTIALITY The Coach will keep the Client’s information private, and will not share the Client’s information to any third party unless compelled to by law. ARBITRATION, CHOICE OF LAW, AND LIMITED REMEDIES In the event that there ever arises a dispute between Coach and Client with respect to the services provided pursuant to this agreement or otherwise pertaining to the relationship between the parties, the parties agree to submit to binding arbitration before the American Arbitration Association (Commercial Arbitration and Mediation Center for the Americas Mediation and Arbitration Rules). Any judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof. Such arbitration shall be conducted by a single arbitrator. The sole remedy that can be awarded to the Client in the event that an award is granted in arbitration is refund of the Program Fee. Without limiting the generality of the foregoing, no award of consequential or other damages, unless specifically set forth herein, may be granted to the Client. This agreement shall be construed according to the laws of the State of California. In the event that any provision of this Agreement is deemed unenforceable, the remaining portions of the Agreement shall be severed and remain in full force. If the terms of this Agreement are acceptable, please sign the acceptance below. By doing so, the Client acknowledges that: (1) he/she has received a copy of this letter agreement; (2) he/she has had an opportunity to discuss the contents with the Coach and, if desired, to have it reviewed by an attorney; and (3) the client understands, accepts and agrees to abide by the terms hereof.
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