Liability Form


WAIVER: In consideration of my participation in the training provided by Coach I, for myself, my heirs, executors, administrators or assigns, do hereby release, waive, discharge and covenant not to sue Coach and/or its members, managers, officers, directors, agents, employees, and affiliated entities (Hereinafter referred to as “Releasees”) from liability, from any and all claims, including the negligence of coach resulting in personal injury, accident or illnesses. (Including Death) and property loss arising from, but not limited to, participation in the coaching wherever located and by whomever provided. I expressly release, hold harmless, discharge and indemnify (Including costs and attorney’s fees) Coach and Releases for any loss, injury or damage (Including Death) from any cause, including negligence arising out of any Location, and/or arising out of the use of services provided by coach.

SEVERABILITY AND JURISDICTION: I further expressly agree that the foregoing provisions in this Agreement are intended to be as broad and inclusive as permitted by the laws of the State of New York and if any portion of this Agreement is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect. I further acknowledge and agree that this Agreement shall be governed by and shall be construed in accordance with the laws of the State of New York . Any claims or legal actions by one party against the other shall be commenced and maintained in the state courts of the State of New York and the parties hereby submit to the jurisdiction and venue of any such court in either state.

INDEMNIFICATION AND HOLD HARMLESS: I also agree to INDEMNIFY AND HOLD coach and all Releasees harmless of any and all claims, actions, suits, procedures, costs, expenses, duties and liabilities, brought as a result of my coaching and to reimburse coach for any such expenses incurred.

(Disregard the below portion if you have Already Paid in Full)

PAYMENTS: The initial term of this Coaching Contract shall be for the term that was agreed upon with AJ Mihrzad (the “Initial Term”) commencing on the date this Coaching Contact is executed by authorized officers of AJ Mihrzad and Client. The first payment will be debited on start of the program with future payment at the 30 day mark or until completion of the program. Please have the payment ready 30 days after your first payment, for each day the payment is late. A $10 daily charge will be applied as interest for each day past the payment due date. If contract is canceled before the term is over, there will be a $999.00 early cancellation fee charged to the Client.

EFT Payment Authorization: Client hereby authorizes coach or its assigns to make periodic charges or withdrawals (“Electronic Funds Transfer Authorization”) from my account as listed below for the payment of any and all fees, expenses or any other monies due coach. Client waives the right to receive prior notice for charges of withdrawals made with respect to any uncollected payments or portions of the balance due described below and the corresponding service charge.

All fields are required.

    Yes. I understand and agree to the above.