Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Marital Status *

Married

Single

Spouse *

Write N/A if single

First Name

Last Name

Do you have children *

Yes

No

Which type of coaching are you interested in? *

Life Coaching

Group Coaching

Leadership Coaching

Seminar

Have you had coaching, counseling, or therapy before? *

Coaching

Counseling

Therapy

No

Waiver *

Being of lawful age and in consideration of being permitted to participate in Coaching Sessions at School of Revivalists Ministries Inc, the Participant (you) releases and forever discharges the Activity Provider (School of Revivalists Ministries Inc), the Activity Provider's spouse, heirs, executors, administrators, coaches, referral recommendations, legal representatives and assigns from all manner of actions, causes of action, debts, accounts, bonds, contracts, claims and demands for or by reason of any injury to person or property, injury resulting in the death of the Participant (You), which has been or may be sustained as a consequence of the Participant's participation in the coaching session, internet or phone calls, activities, and not withstanding that such damage, loss or injury may have been caused solely or partly by the negligence of the Activity Provider. Illnesses: By signing this agreement, I acknowledge the contagious nature of COVID-19 and voluntarily assume the risk that I may be exposed to or infected by COVID-19 by attending the School of Revivalists Ministries Inc (SOR) Coaching Sessions and that such exposure or infection may result in personal injury, illness, permanent disability, and death. On my behalf, I hereby release, covenant not to sue, discharge, and hold harmless School of Revivalists Ministries Inc.,, its employees, coaches, agents, relatives, and representatives, of and from the Claims, including all liabilities, claims, actions, damages, costs or expenses of any kind arising out of or relating thereto. Type Legal Name in the fields below.

First Name

Last Name

Date *

MM

DD

YYYY

I hereby certify that the above statements are true and correct to the best of my knowledge. I understand that a false statement may disqualify me from admissions, continued enrollment, refunds, privileges, and association with School of Revivalists Ministries Inc. *

First Name

Last Name