Kids at Risk for Diabetes LLC
Private Consulting Monthly Program
**If Client is under the age of 18, a parent or legal guardian must sign on his/her behalf. Please change signature accordingly to include both the parent and the child.
Company agrees to provide monthly support to parents of children at risk for chronic disease due to heredity plus life style. During this time period, participants can contribute at will to the private Facebook page. Client is entitled to contribute at will to the Facebook page but the administrator will monitor all contributions for accuracy and diplomacy. If administrator deems necessary, entries will be deleted without notice. Client corresponds via email once a week, coach may delay response and limit personalized guidance to one email per week. A Facebook page will also be provided for community support (herein referred to as the “Program”). Administrator will monitor and edit as he/she deems necessary. Client agrees to abide by all policies and procedures as outlined in this agreement as a condition of their participation in the Program.
I have used care in preparing the information provided to you, but this Program and my Program materials are being provided as self-help tools for your own use and for informational and educational purposes only. There are many factors that influence results, so no guarantees can be made as to the results you will experience through this Program. You agree that I am not responsible for your physical, mental, emotional and spiritual health, for your financial earnings or losses, or for any other result or outcome that you may experience through this Program.
Client understands Coach is not an employee, agent, lawyer, doctor, registered dietician, psychotherapist, nutritionist, psychologist, or other licensed or registered professional. Although at this time, I am an Indiana state registered nurse, I cannot and do not practice in any state outside of Indiana. I also cannot predict when I will officially retire and allow my registered nurse license and my certification for diabetes education to expire. Therefore I should not be considered a practicing (licensed) registered nurse or certified diabetes educator at any time and I am not holding myself out as such at any time or giving medical or nursing advice in any capacity. Coach will not act as a therapist providing psychoanalysis, psychological counseling or behavioral therapy. Client understands this Program will not prescribe or assess micro-and macronutrient levels; provide health care, medical or nutrition therapy services; or diagnose, treat or cure any disease, condition or other physical or mental ailment of the human body. Client understands if they should experience any such issues they should see their registered physician or other practitioner as determined by their own judgment.
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. Client understands that the information in this Program is NOT medical or nursing advice and is not meant to take the place of seeing licensed health professionals.
**Initials _____ (if client is under 18 years old, please include parent/guardian signature.) Please return to Julie@kidsatriskfordiabetes.com
Parent signature: _____________________________________
Total price of this monthly consultation three month introductory program is $897.95 American dollars. Client may pay by monthly installments through PayPal, debit or credit card at $320.00 per month. If paying by PayPal, or debit card or credit card via PayPal, you give us permission to automatically charge your credit card or debit card as payment for your Program without any additional authorization, and you will receive an electronic receipt. If I choose to provide you with a PayPal invoice instead, you are required to manually pay it by the date due on the invoice or your Program will be put on hold until payment is made. If payment is not received by the date due or there is a problem with the payment transaction or method, you will be notified by e-mail and then have a 3 day grace period to make the payment following the assigned due date, otherwise your Program will be put on hold. If no payment is made within the 3 day grace period, the Program will automatically terminate and you will no longer be granted access. After the three month introductory program, you will be automatically charged $257.73 per month until you notify provider via email to Julie@kidsatriskfordiabetes.com of you intent to discontinue consultation services.
It is Company’s intention for Client to be happy with the Program. However, because Company has invested considerable time and effort in the Program, if Client decides to withdraw at any time for any reason during the three month introductory period, Client is still fully responsible for making all Program payments, and no monthly refunds will be provided. When discontinuing this monthly support program, Client will notify Company of intention within 2 days of being discontinued.
5. PROGRAM STRUCTURE.
● This Program is a weekly one on one phone counseling service plus a support group via Face Book. Client will need to submit a request to join the group before Face Book program can begin. Please allow Company 3 days to approve request.
● Email access: Julie@kidsatriskfordiabetes.com
Expectations and Guidelines:
● Come prepared with accurate information to contribute.
● Serve as your accountability partner and supporter.
● Offer support, encouragement, feedback and guidance.
● Promptly provide monthly payment for the Program.
● Be open to new ideas and willing to stretch and grow.
● Ask any questions you may have as they arise.
● Questions can be submitted via email.
● Understand that the power of the coaching relationship can only be granted by you, and commit to making the relationship powerful. If you see that the coaching is not working as you desire, communicate and take action to return the power to the relationship.
Rescheduling: If you need to reschedule an appointment, you need to do so at least 24 hours in advance of your scheduled time by sending an e-mail to Julie@Kidsatriskfordiabetes.com.
Cancellation: Our time together is important. If you need to cancel your appointment, you need to do so at least 24 hours in advance of your scheduled time by sending an e-mail to me. If you do not contact me at least 24 hours in advance, this will be considered a missed appointment. All cancelled appointments will be made up at the discretion of facilitator.
Missed Appointment: There can be a rare occasion where you miss your appointment altogether or you forget to let me know at least 24 hours in advance that you need to cancel or reschedule, so you are allowed 1 “Get Out of Jail Free” missed appointment. However, you are only permitted to miss 1 appointment during the 3 month introductory period. If you miss more than 2 appointment, your Program may be terminate at the discretion of the facilitator and you will not have the opportunity to reschedule or to receive a refund. You may file an appeal via email to Julie@kidsatriskfordiabetes.com
This Program is a weekly individualized phone consultation and begins after approved. (“Term”). Client understands that a relationship with Company does not exist between the Parties after the discontinuation of the Program. If the Parties desire to continue their relationship, a separate monthly agreement will be entered into.
Company is committed to providing all clients in the Program with a positive Program experience. By signing below, Client agrees that the Company may, at its sole discretion, terminate this Agreement and limit, suspend or terminate Client’s participation in the Program without refund or forgiveness of monthly payments if Client becomes disruptive or upon violation of the terms. If Client decides to terminate this Agreement, no refunds will be issued.
This Agreement is considered a mutual non-disclosure agreement. Both Parties agree not to disclose, reveal or make use of any information learned by either party during discussions, Or otherwise, throughout the Term of this Program (“Confidential Information”). Confidential Information includes, but is not limited to, information disclosed in connection with this Agreement, and shall not include information rightfully obtained from a third party. Both Parties shall keep all Confidential Information strictly confidential by using a reasonable degree of care, but not less than the degree of care used by it in safeguarding its own confidential information. The obligation of the Parties hereunder to hold the information confidential does not apply to information that is subsequently acquired by either Party from a third party who has a bona fide right to make such information available without restriction. Both Parties agree that any and all Confidential Information learned as of the Effective Date shall survive the termination, revocation, or expiration of this Agreement.
9. COMPELLED DISCLOSURE OF CONFIDENTIAL INFORMATION.
Notwithstanding anything in the foregoing, in the event that Client is required by law to disclose any of the Confidential Information, Client will (i) provide Company with prompt notice of such requirement prior to the disclosure, and (ii) give Company all available information and assistance to enable Company to take the measures appropriate to protect the Confidential Information from disclosure.
10. INTELLECTUAL PROPERTY RIGHTS.
Company retains all ownership and intellectual property rights to the Program content and materials provided to Client through the Program, including all copyrights and any trademarks belonging to Company. The Program content and materials are being provided to you for your individual use only and with a single-user license which means that you are not allowed or authorized to share, copy, sell, post, distribute, reproduce, duplicate, trade, resell, exploit, or otherwise disseminate any portion of the Program or Program materials, electronically or otherwise, for business or commercial use, or in any other way that earns you money, without my prior written permission.
Further, by signing below, Client agrees that if Client violates, or displays any likelihood of violating, any of Client’s agreements contained in this paragraph, Company will be entitled to injunctive relief to prohibit any such violations and to protect against the harm of such violations.
If there is a dispute between the Parties, Client agrees to not publicly or privately make any negative or critical comments about the Program, Company’s business or me, or to communicate with any other individual, company or entity in a way that disparages the Program or harms the Company’s reputation in any way, including on social media. In arbitration or when required by law, of course, you are not prohibited from publicly sharing your thoughts and opinions
Client agrees to indemnify and hold harmless Company, its affiliates, and its respective officers, directors, agents, employees, and other independent contractors from any and all claims, demands, losses, causes of action, damage, lawsuits, judgments, including attorneys’ fees and costs, arising out of, or relating to, Client’s participation or action(s) under this Agreement. Client agrees to defend against any and all claims, demands, causes of action, lawsuits, and/or judgments arising out of, or relating to, the Client’s participation under this Agreement, unless expressly stated otherwise by Company, in writing.
All correspondence or notice required regarding the Program shall be made to me by e-mail at Julie@kidsatriskfordiabetes.com and to you at the e-mail address you provided during your enrollment in the Program. Should your e-mail address, billing information, or contact information change at any time throughout the Program, it is your responsibility to provide your updated information to me within 3 days of any change.
14. DISPUTE RESOLUTION.
If a dispute is not resolved first by good-faith negotiation between the Parties to this Agreement, every controversy or dispute to this Agreement will be submitted to the American Arbitration Association. The arbitration shall occur within ninety-(90)-days from the date of the initial arbitration demand and shall take place in Columbus, Indiana USA. The Parties shall cooperate in exchanging and expediting discovery as part of the arbitration process and shall cooperate with each other to ensure that the arbitration process is completed within the ninety-(90)-day period. The written decision of the arbitrators (which will provide for the payment of costs, including attorneys’ fees) will be absolutely binding and conclusive and not subject to judicial review, and may be entered and enforced in any court of proper jurisdiction, either as a judgment of law or decree in equity, as circumstances may indicate.
15. GOVERNING LAW.
This Agreement shall be governed by and construed in accordance with the laws of the state of Indiana, USA regardless of the conflict of laws principles thereof.
16. ENTIRE AGREEMENT; AMENDMENT; HEADINGS.
This Agreement constitutes the entire agreement between the Parties with respect to its relationship, and supersedes all prior oral or written agreements, understandings and representations to the extent that they relate in any way to the subject matter hereof. Neither course of performance, nor course of dealing, nor usage of trade, shall be used to qualify, explain, supplement or otherwise modify any of the provisions of this Agreement. No amendment of, or any consent with respect to, any provision of this Agreement shall bind either party unless set forth in a writing, specifying such waiver, consent, or amendment, signed by both parties. The headings of Sections in this Agreement are provided for convenience only and shall not affect its construction or interpretation.
This Agreement may be executed in one or more counterparts (including by means of facsimile or electronic mail via portable document format), each of which shall be deemed an original but all of which together will constitute one and the same instrument.
Should any provision of this Agreement be or become invalid, illegal, or unenforceable under applicable law, the other provisions of this Agreement shall not be affected and shall remain in full force and effect.
The waiver or failure of Company to exercise in any respect any right provided for herein shall not be deemed a waiver of any further right hereunder.
This Agreement may not be reassigned by either Party without express written consent of the other Party.
21. FORCE MAJEURE. In the event that any cause beyond the reasonable control of either Party, including without limitation acts of God, war, curtailment or interruption of transportation facilities, threats or acts of terrorism, State Department travel advisory, labor strike or civil disturbance, make it inadvisable, illegal, or impossible, either because of unreasonable increased costs or risk of injury, for either Party to perform its obligations under this Agreement, the affected Party’s performance shall be extended without liability for the period of delay or inability to perform due to such occurrence.
22. CLIENT RESPONSIBILITY; NO GUARANTEES.
Client accepts and agrees that Client is 100% responsible for its progress and results from the Program. Company will help and guide Client; however, participation is the one vital element to the Program’s success that relies solely on Client. Company makes no representations, warranties or guarantees verbally or in writing regarding Client’s performance. Client understands that because of the nature of the program and extent, the results experienced by each client may significantly vary. By signing below, Client acknowledges that there is an inherent risk of loss of capital and there is no guarantee that Client will reach its goals as a result of participation in the Program and Company’s comments about the outcome are expressions of opinion only. Company makes no guarantee other than that the Services offered in this Program shall be provided to Client in accordance with the terms of this Agreement.
[Signature Page to Follow]
IN WITNESS WHEREOF, the Parties, intending to be legally bound, have executed this Client Agreement as of the date first indicated above. Signing indicates that parent/guardian has legal authority concerning the child/children in this program.
Kids at Risk for Diabetes LLC Client/guardian signature and date:
By: ___________________________ _____________________________
Julie Stelting RN CEO
(to be signed and dated after received) Parent/guardian signature required if client is under 18 years old.