Authorization and Agreement iBloom in June


Hi there!

This agreement has 2 simple parts. The first is a coaching agreement form. The second is an agreement that the materials presented in the intensive are proprietary and for personal use only. Please read them over. We thank you for your time, attention and agreement.

We look forward to seeing you and working with you on the intensive soon!

AUTHORIZATION AND AGREEMENT

  1. The 6-part webinar Intensive, I Bloom in June(referred to hereafter as “ The Coaching”) is for people who are basically well-adjusted, emotionally healthy, and functioning effectively, but who want to make changes in their lives.*  The Coaching is not therapy, counseling, advice-giving, mental health care, or treatment for substance abuse. In these sessions, the Coaches (including Dr. Lonsdorf who is a licensed medical doctor, and Ziv Soferman, PhD in computer science), are not functioning as licensed health professionals, and the Coaching is not intended to form a doctor-patient relationship or as a replacement for counseling, psychiatric interventions, treatment for mental illness, recovery from past abuse, professional medical advice, financial assistance, legal counsel, or other professional services.
  2. If I am currently in therapy, have a history of mental illness or are taking (or have in the past taken) medication for mental or emotional health, I agree to discuss the appropriateness of this program with my therapist before participating.*
  3. I agree that I will not suspend medical or psychiatric treatment on the basis of the Coaching, but will consult with my prescribing physician or therapist before making such changes under his or her supervision.*
  4. The Coaching goals or objectives could include (but are not limited to) career development, relationship enhancement, spiritual growth, lifestyle management, life balance, decision-making, and achieving short-term or long-term goals.*
  5. The Coaching may use inquiry, reflection, discussion, exercises and other approaches to help clarify issues and promote progress towards the client’s goal(s).*
  6. The effectiveness of the Coaching requires that both the Coaches and the client are honest and straightforward in their communication. I agree to be honest in my communication,* though I understand I may use a pseudonym or “stage name” with my homework submissions.
  7. Any comments made by the Coach regarding aspects of my physical, mental or emotional health, my body and its physiological functioning I understand are meant for educational purposes and are not diagnostic of the presence or absence of disease. I agree to consult with my personal physician, psychiatrist or psychotherapist, as appropriate, outside of the session for further evaluation of my mental, physical or emotional health issues.*
  8. I represent that I am fully responsible for my own life and decisions and accept full responsibility for such decisions, including decisions regarding issues discussed in the Coaching.*
  9. Coaching is a confidential relationship. The Coaches agree to keep all information strictly confidential, except in those situations where such confidentiality would violate the law and in the case of webinars as described in the paragraph below.* 

    For Coaching sessions in webinar format, I agree that any material I submit to the coaches regarding my issues, goals and any associated information I provide, as well as the coaches’ highly personal insights and interpretation of my issues, and my voice and the content of what I say should I choose to be coached live during the webinar may all be used during the webinar and in subsequent use of the recording, on a no-name basis unless I provide written consent for my identity to be disclosed.*

  10. I hereby acknowledge that no claims or guarantees have been made to me in any way in connection with the Coaching regarding achieving any specific goals, objectives, benefits or improvements in my life or health condition.*
  11. Data of any surveys or narrative report of the benefits I receive from the consultation may be used in research or promotional materials, but that my name will not be used without my consent.*
  12. I also understand that results may vary as a result of participation in The Coaching, and no specific results are promised or guaranteed.*
  13. Choice of Law and Venue. This Agreement shall be governed by the laws of the State of Iowa and any action or proceeding in connection with this Agreement shall be brought in any court of record of the State of Iowa, County of Jefferson, or in the United States District Court for the Eighth District of Iowa.*

PROPRIETARY MATERIALS AGREEMENT

I understand that all materials, concepts, and information (collectively “Materials”) presented by  (“Soferman and Lonsdorf Coaching LLC”) during this program, either orally or in writing, are the property of Soferman and Lonsdorf Coaching LLC and are protected by copyright, trade secret, and other applicable laws. I acknowledge that the Materials constitute commercially valuable, proprietary, confidential property of Soferman and Lonsdorf Coaching LLC, the design and development of which required the investment of substantial effort, time, and money.

All rights in the program and the Materials are expressly reserved by Soferman and Lonsdorf Coaching LLC. I agree not to reproduce, copy, or otherwise duplicate, and not to distribute, lend, or otherwise transfer, the Materials without the prior written permission of Soferman and Lonsdorf Coaching LLC.

I agree not to use the Materials in any way that would compromise the confidential and proprietary nature of the Materials.

I understand that the Materials presented by Soferman and Lonsdorf Coaching LLC in this program are intended solely for use in the program.

I understand that while I am free to use the Materials for my own personal use, and free to tell others about the benefits I realized from the program, I agree not to resell, reproduce and sell, modify and sell, or repackage and sell the Materials. I agree that

I will not use the Materials for any purpose other than my own personal use except with the prior written permission of Soferman and Lonsdorf Coaching LLC. I agree not to deliver the Materials themselves, either reproduced or modified, or anything derived from the

Materials, either orally or in writing, as part of any seminar, training program, workshop, consulting, or similar business activity which I make available to my clients or to others, except with the prior written permission of Soferman and Lonsdorf Coaching LLC.

I agree that this Agreement supersedes any prior agreements I may have regarding the use of the Materials and that, if necessary, I will again obtain Soferman and Lonsdorf Coaching LLC’s written permission before using any materials which I may have obtained permission to use in the past.

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Nancy K. Lonsdorf, MD https://drlonsdorf.com
Signature Certificate
Document name: Authorization and Agreement iBloom in June
Unique Document ID: b278176d263b5664f5616cd3d49bde708b170871
Timestamp Audit
June 10, 2019 3:35 pm CSTAuthorization and Agreement iBloom in June Uploaded by Nancy K. Lonsdorf - nlonsdorf@gmail.com IP 76.76.236.28