Liability Waiver & NDA


This agreement, between coach Jacqueline Pugh, Jacqui Pugh and the above-named client for one-on-one coaching and participation in the BURN program, will begin on ______. The payment of $___ was made on ___, with the last __ payments of $___ each being made on or before the ___ day of each month. BURN may be renewed at the same rate of $____  after the duration of this initial program. One-on-one coaching at the discounted rate of $___ for four one-on-one coaching sessions may be renewed at the same rate; these four coaching sessions are valid for one year beginning today.

The services to be provided by the coach to the client are four 30-45 minute calls/FaceTime not to exceed one hour and up to 10 “text” reach outs each month, followed by tele-coaching, as designed for the BURN program. Coaching, which is not advice, therapy, or counseling, may address specific personal projects, relationships, business successes, or general conditions in the client’s life or profession. The client understands that the coach will respond to “text” messages at their earliest convenience.

Throughout the working relationship, the coach may engage in direct and personal conversations. The client can count on the coach to be honest and straightforward in asking questions and making requests. The client understands that the power of the coaching relationship can be granted only by the client, and the client agrees to do just that: have the coaching relationship be powerful. If the client believes they need something communicated in a different way, the client will communicate that belief immediately and privately to the coach and take action to return the power to the coaching relationship, jointly coming up with possible solutions.


***The coach and client agree that all information provided by each of them and from others associated with the BURN program will be kept strictly confidential!!! The coach and client may mutually agree upon sharing certain information for a public testimonial. The coach may have admin help with organization of client files and payments. The admins will sign an NDA to keep client information confidential. Coach and client agree to keep this a safe, positive environment for all involved. Client agrees that they will not coach others but they will be supportive.  Inviting a kind, different point of view for another client is welcome if the other client has asked for additional views, otherwise, everyone will remain supportive of each other’s choices.

The coach and client both agree to be 100% honest when communicating for the client to receive the most beneficial coaching. Coach and client agree to keep this a safe, kind, nonjudgmental, loving, and positive environment. Client agrees and understands that there may be moments when the coach feels “tough love” is necessary. Client agrees to not take it personally and/or get defensive and trusts that the coach is doing what they feel is best in that moment to help benefit the client. If the client feels uncomfortable, client agrees to kindly address it immediately to the coach so they may agree upon a different course of action to be taken to make the client feel more comfortable and still take steps toward their goals.

This program, Jacqueline Pugh, Jacqui Pugh, or any of it’s affiliates do not guarantee any expected results. What each client chooses to put in is what they will get out. Every homework assignment is a suggestion rather than a requirement, therefore, if a client feels something is not right for them, they have the choice to trust themselves, openly communicate that to their coach and focus more on other assignments.

Jacqueline Pugh, Jacqui Pugh is not a licensed therapist or registered dietitian. If any traumatic situations come up for a client, she has affiliate coaches who specialize in trauma that she can suggest referring the client to. She will be supportive in the client receiving additional guidance but the cost for the specialist will be at the client’s own expense. If an emergency arises, it is advised to call 911. If a health condition arises, client agrees to seek professional medical help. Client agrees that they have no health issues and are in a healthy, safe condition to perform self-development work and exercise. Client agrees if something is too intense for them, they will communicate that to the coach and agree upon a modified course of action.


RESCHEDULE POLICY: 24 hour notice must be given to reschedule your one-on-one session. If less than a 24 hour notice to reschedule is given, the session shall be forfeited and will count as a paid session. A session may not be rescheduled more than once. If the client cannot make the initial reschedule, the session shall be forfeited by the client and will count as a paid session.

If client causes any harm (including emotional and mental) or disturbance to the group or to Jacqui Pugh, Jacqueline Pugh, the coach reserves the right to remove the client at their own discretion from the coaching program with no refund.

It is a safe, supportive environment. If a client seems unsupportive or negative towards themselves or others, including ex-bashing, at the discretion of Jacqueline Pugh, Jacqui Pugh, they will kindly be asked why, to dig deep, be authentic with themselves in order to have an open discussion with Jacqueline Pugh, Jacqui Pugh on the topic, and to apologize to someone if they were hurt from the act.  If it happens a second time, at the discretion of Jacqueline Pugh, Jacqui Pugh, the client will be removed from the course with no refund.

If a client is dissatisfied or wishes something was done slightly differently to feel more fulfilled, it shall be addressed directly to none other than Jacqueline Pugh, Jacqui Pugh so she may make an educated decision as to whether or not something may be modified to be a benefit. No bad reviews are welcome. If there is an issue, it shall be addressed directly with Jacqueline Pugh, Jacqui Pugh in a kind manner as she would like to be made aware and be hands-on in addressing issues to make a great environment for everyone involved!

Client understands that there may points where a plateau is reached. This is normal when going through changes. Client agrees to let the flow naturally happen and continue to dig deep to uncover their potential.

Client agrees to not hold Jacqueline Pugh/Jacqui Pugh liable for any incidents that may occur before, during, or after the coaching program, including death.

Client agrees to not share or duplicate any information provided by or related to BURN, Jacqui Pugh, Jacqueline Pugh or affiliates.

This contract uses the following program as an outline: Co-Active Coaching (3rd ed.) © 2011 by Henry Kimsey-House, Karen Kimsey-House and Phillip Sandahl. Permission is hereby granted to reproduce this page for client use. Duplication for any other use, including resale, is a violation of copyright law.

Jacqueline Pugh, Jacqui Pugh

Coaching and BURN Program

Commencement of Program: ____

I, ____, acknowledge that I am here to inspire my own personal growth and transformation. I, alone, am responsible for the well-being and perception of my life. I take full responsibility for my individual experience and outcome associated with coaching and the BURN program and beyond. Under no circumstances will Jacqueline Pugh, Jacqui Pugh, their associates or affiliates be held responsible for my actions or circumstances. Heirs, guardians, legal representatives of/and Jacqueline Pugh, Jacqui Pugh hereby and forever release, waive, and discharge any claims against Jacqueline Pugh, Jacqui Pugh, and any of their associates or affiliates.

I also acknowledge that this program’s intention is to provide a sacred space of trust and privacy for those involved. As a member of coaching and the BURN program, I agree to honor the sanctity of confidentiality while immersed in coaching and the BURN program. I agree to maintain said confidentiality for the extent of my human existence.

In addition, I acknowledge that coaching and the BURN program does not allow for cancellations or refunds of any kind. I recognize that the space I have agreed to occupy is a sought after position. Should I decide at any point that I no longer wish to participate in coaching and the BURN program to any extent, I do so with the complete awareness that I will not receive compensation of any sort or a refund in any amount.

I have carefully and thoroughly read and understand this agreement. I am aware that with my signature, I am agreeing to and am legally bound to the aforementioned statements.

I accept these terms with gratitude for my individual free will choices.

___________________________ _______ Client (Print Name) Date

___________________________ _______ Client (Signature) Date


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