Wellness & Lifestyle Coaching Intake

TOTAL TRANSFORMATION COACHING

Intake/Waiver/Release and Agreement

Let's Get To Know A Bit About You

What gender do you best "Identify" with?

What experience do you have with a "Nutrition or Fitness Coach"?

What experience do you have with a "Lifestyle Coach", if any?

What has your "Exercise History" been like in the past 2 years?

Are you currently registered with "Starr Fit Club" for fitness coaching?

What is your current "Outlook" for wellness and nutrition goals?

What are your primary "Health and Wellness Goals?

Select a "Goal" you hope to accomplish with nutrition coaching?

What type of "Specific Diet" have you been following (if any)?

Are there any "Food Allergies" we should be aware of?

How "Difficult" do you find following a specific lifestyle plan and diet?

How "Motivated" are you about keeping focused on a target goal?

On a scale of 1 to 10, rate your current "Energy and Willpower"?

Do you find it difficult to "Take or Act" on instructions given by a coach?

Would you say that road blocks have made sticking to a "Diet" difficult?

Would you say that road blocks have made sticking "Exercise" difficult?

How knowledgable are you concerning "Nutrition & Exercise" balance?

How would you describe your current state of "Focus" in life?

In your opinion, how can we use "Coaching" to help you best?

Are you going through any "Hormonal or Emotional" changes?

How would you rate your current levels of "Stress", if any?

Approximately how many "Hours" do you sleep each night?

How did you hear about "Starr Fit Club"?

Wellness Health History

Do you currently have any gastrointestinal issues diagnosed?

Has a physician ever recommended you go on a "Special Diet"?

Are you "Currently Pregnant" or think you may be?

List all medications you're currently taking and dosage?

List all conditions you've had medical treatment for in the past year?

List all past and recent injuries, surgeries, or accidents?

Do you live with any current physical or mental disabilities?

POLICIES

No-Show/Lateness/Cancellation Policy

In the event that the Client does not show up to an appointment or cancels within 24 hours of a scheduled zoom live appointment (when required by client and set date was logged) the Nutrition Coach Marisol Garner and/or "Starr Fit Club", reserves the right to charge the client a $20 (no-show fee) and reserves the right to refuse the attendance of the client session meet date(s) in the future regardless if an additional date is set or dates are already in place by client seeking to use those date(s) until the client makes the (no-show fee) payment in advance prior to any rescheduled date(s) by Client or Coach in order to resume any wellness coaching session(s).

The above may be disregarded in the event of an actual emergency, the client must provide documentation showing incident and any immediate relationship to client personally in which they must become present to address such as but not limited to child accident or illness, spouse car accident, or self-accident involvement or serious hospitalization or illness resulting in urgent care or hospital visit/admission in any case.

In the event that the Client is late beyond the allotted 15-min window, the coach Marisol Garner reserves the right to close the attendance meeting and label it a no-show, therefore client will accrue a charge (no-show fee) in the amount of $20 and will be treated with the same rules as the above mentioned requiring a no-show payment to be made before the client is able to hold coach accountable for attending any future Zoom meeting(s) regardless of any prior set date(s), or future date(s) set by the client or coach.

WELLNESS NUTRITION COACHING AGREEMENT

The details of your customized coaching plan are made a part of this Agreement. In consideration of our preliminary communications and your receipt of a coaching services, you agree to the following:

Coaching

Welcome to online coaching. It is my hope that we can help your reach your goals and improve your health. With any of the work we do, I want to be clear that I am not prescribing any medications, trying to treat or cure any illnesses. Only a medical physician can do this. All advice from Marisol Garner, NASM Certified Holistic and Sports Nutrition Coach is given as if she was saying what she would do in your particular situation for herself, and serves only for the purpose of providing the Client recommendations as a perspective to aid in the process of body composition management.

Payment & Fees

Payments are due in full prior to the start of your service and there are no refunds for payment made to Marisol Garner or Starr Fit Club, once the program is started and you've gone beyond the first week in a given month after you have completed your first 90-day minimum new client wellness plan upfront cost). You agree to the designated fees at the time of purchase with a minimum (3) month commitment for online coaching. We need this as a minimum to make progress. Payment is made through signing up for recurring payments through Pay Pal or with a credit/debit card on file and must be made in advance of services for the first 90 days. Thereafter; you will have the option of choosing a month-to-month nutrition coaching plan for maintenance and follow up with your nutrition coach using our online coaching platform via NASM Edge app (required use of technology from your mobile devices, in addition to periodic Zoom live meet as necessary, not to exceed twice a month and sessions do not transfer to the next month if unused.

Confidentiality

Client information and records are confidential unless I receive your advance permission to disclose or except as required by law. All of our conversations and information exchanged is confidential. If I would like to post a picture of you to my social media, I will get permission from you first. If I intend to use your self-written testimonial on my website or voice, likeness, interview or other forms of social media share, or marketing purpose, I will ensure your permission is granted by asking you to sign a release form giving me permission.

Coach Responsibilities

Coach Starr (preferred name to use) and with legal name of Marisol Garner will do everything in her power to return emails within 24 hours of receipt. There are times when this is delayed due to travel where it will be indicated in an auto-reply email. Typically, emails are answered in the order they come in, though, clients that are 5 weeks out or less from a competition or an event might get priority. In the event that a quick response is needed please put "URGENT" in all caps in the Subject line. Please do your best to adhere to your check in times. If you need to change your day, please let me know. I also make myself available to emails from clients for questions about their programs at any time and again will do my best to get back to you within the day.

Client Responsibilities

The Client acknowledges that the Client takes full responsibility for the Client's life an 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 the duration of the client's nutrition and wellness coaching sessions.

The Client expressly assumes the risks of nutrition and wellness coaching sessions, including the risks of trying new foods, and the risks inherent in making lifestyle changes.

The Client releases Marisol Garner Certified Holistic and Sports Nutrition Coach with Starr Fit Club from any and all liability, damages, causes of action, allegations, suits, sums of money, claims and demands whatsoever, in lay or equity, which the Client ever had, now has or will have in the future against the Nutrition Wellness Coach, arising from the Client's past or future participation in, or otherwise with respect to, the nutrition sessions, unless arising from the gross negligence of the Nutrition Wellness Coach.

The Client agrees to cooperate in completing the initial questionnaires/food logs/other assessment material I need from you in a timely manner so productive coaching can occur. You will check in at the appropriate agreed upon time (usually every week). You also agree to a minimum of three months of online coaching once signed up. You have the sole responsibility to contact your physician for approval for participation in coaching if coaching is for health reasons. You recognize that any activity in which problems/life situations are discussed bears some risk, which you the Client agree to accept in its entirety.

The Client agrees to hold harmless and indemnify Marisol Garner and Starr Fit Club, including any representatives from any liability whatsoever resulting from your participation in coaching activities, including but not limited to medical expenses. You accept the risk of any decision, action or outcome based on the coaching relationship. You acknowledge that expectations and results or participation in coaching activities vary among individuals and that each individual may not receive the same benefit.

The Client agrees that Coach may discontinue services to you upon notification to you in writing for any reason, including the following: your failure to cooperate to the best of your ability in the activities and schedules planned; non-payment of fees within 5 days of the due date. Client shall provide at least a two (2) week notice to Coach if client wishes to discontinue coaching services after the minimum (3) month coaching period.

DISCLAIMER

Marisol Garner better known as Coach Starr is not a Doctor or Registered dietitian, and does not dispense medical advice nor prescribe treatment. Client acknowledges that the coach is a National Academy of Sports Medicine (NASM) Certified Holistic and Sports Nutrition Coach working with individual's on improving their body composition and overall health.

If the Client is under the care of a healthcare professional or currently uses prescription medications, the Client should discuss any dietary changes or potential dietary supplement use with their primary care physician, and should not discontinue any prescription medications without first consulting their primary care physician.

The Client acknowledges that the care that they receive during their nutrition and wellness coaching sessions is separate from the care that they receive from any medical facility in that the nutrition coaching session are in no way intended to be construed as medical advice or care. The Client should continue regular medical supervision and care by their primary care physician and even a registered dietitian recommended by physician.

The contents of this document should not be taken as medical advice. It is not intended to diagnose, treat, cure, or prevent any health problem ‐ nor is it intended to replace the advice of a physician. Always consult your physician or qualified health professional on any matters regarding your health.

All documents included or exchanged between Marisol Garner and the Client are not to be copied, sold or redistributed without the consent of Marisol Garner, legal owner, content creator, of all copyright materials as distributed to clients by coach Starr of Starr Fit Club..

Waiver and Release of Liability

In consideration of the risk of injury while participating in Online Coaching or at physical location (if or when applied) with Marisol Garner with Starr Fit Club and as consideration for the right to participate in the Activity, I hereby, for myself, my heirs, executors, administrators, assigns, or personal representatives, knowingly and voluntarily enter into this waiver and release of liability and hereby waive any and all rights, claims or causes of action of any kind whatsoever arising out of my participation in the Activity, and do hereby release and forever discharge Marisol Garner and Starr Fit Club 4606 Woolworth Street Houston, TX 77026, and affiliates, for any physical or psychological injury, including but not limited to illness, paralysis, death, damages, economical or emotional loss, that I may suffer as a direct result of my participation in the aforementioned Activity, including traveling to and from an event related to this Activity, online coaching or other forms of communications while receiving wellness and nutrition coaching services.

I am voluntarily participating in the aforementioned activity and I am participating in the activity entirely at my own risk.

I am aware of the risks associated with traveling to and from as well as participating in this activity including online communication, which may include, but are not limited to, physical or psychological injury, pain, suffering, illness, disfigurement or bruising, temporary or permanent disability (including paralysis), economic or emotional loss, and death. I understand that these injuries or outcomes may arise from my own or others negligence, conditions related to travel, or the condition of the activity location(s) regardless of on-site location or online interactions and communications with coach.

Nonetheless, I assume all the related risks, both known or unknown to me, of my participation in this activity, including travel to, from, and during this activity.

I agree to indemnify and hold harmless Marisol Garner and Starr Fit Club against any and all claims, suits or actions of any kind whatsoever for liability, damages, compensation or otherwise brought by me or anyone on my behalf, including attorney's fees and any related costs, if litigation arises pursuant to any claims made by me or by anyone else acting on my behalf. If Marisol Garner incurs any of these types of expenses, I agree to reimburse Marisol Garner. I acknowledge that Marisol Garner and their directors, officers, volunteers, representatives and agents are not responsible for errors, omissions, acts or failures to act of any party or entity conducting a specific event or activity on behalf of Marisol Garner.

I acknowledge that this activity may involve a test of a person's physical and mental limits and may carry with it the potential for serious injury, death, and property loss.

The risks may include, but are not limited to, those caused by terrain, facilities, temperature, weather, lack of hydration, condition of participants, equipment, vehicular traffic and actions of others, including but not limited to, participants, volunteers, spectators, coaches, event officials and event monitors, and/or producers of the event.

I ACKNOWLEDGE THAT I HAVE CAREFULLY READ THIS "WAIVER AND RELEASE" AND FULLY UNDERSTAND THAT IT IS A RELEASE OF LIABILITY. I EXPRESSLY AGREE TO RELEASE AND DISCHARGE MARISOL GARNER AND STARR FIT CLUB AND ALL OF ITS AFFILIATES, MANAGERS, MEMBERS, AGENTS, ATTORNEYS, STAFF, VOLUNTEERS, HEIRS, REPRESENTATIVES, PREDECESSORS, SUCCESSORS AND ASSIGNS, FROM ANY AND ALL CLAIMS OR CAUSES OF ACTION AND I AGREE TO VOLUNTARILY GIVE UP OR WAIVE ANY RIGHT THAT I OTHERWISE HAVE TO BRING A LEGAL ACTION AGAINST MARISOL GARNER OR STARR FIT CLUB FOR PERSONAL INJURY OR PROPERTY DAMAGE.

To the extent that statute or case law does not prohibit releases for negligence, this release is also for negligence on the part of Marisol Garner, its agents, and employees. In the event that I should require medical care or treatment, I agree to be financially responsible for any costs incurred as a result of such treatment. I am aware and understand that I should carry my own health insurance. In the event that any damage to equipment or facilities occurs as a result of my or my family's willful actions, neglect or recklessness, I acknowledge and agree to be held liable for any and all costs associated with any actions of neglect or recklessness.

This Agreement was entered into at arm's-length, without duress or coercion, and is to be interpreted as an agreement between two parties of equal bargaining strength. Both the participant also known as ("The Client") whom is voluntarily signing this agreement and Marisol Garner are of equal bargaining strength. Both the Participant and coach agree that this Agreement is clear and unambiguous as to its terms, and that no other evidence will be used or admitted to alter or explain the terms of this Agreement, but that it will be interpreted based on the language in accordance with the purposes for which it is entered into.

In the event that any provision contained within this Release of Liability shall be deemed to be severable or invalid, or if any term, condition, phrase or portion of this agreement shall be determined to be unlawful or otherwise unenforceable, the remainder of this agreement shall remain in full force and effect, so long as the clause severed does not affect the intent of the parties. If a court should find that any provision of this agreement to be invalid or unenforceable, but that by limiting said provision it would become valid and enforceable, then said provision shall be deemed to be written, construed and enforced as so limited.

I, the undersigned participant, affirm that I am of the age of 18 years or older, of sound mind, and that I am freely signing this agreement.

I certify that I have "read this agreement to its entirety" and that I fully understand its content and that this release cannot be modified orally.

I am aware that this is a release of liability and a contract and that I am signing it of my own free will.