My full name: *

First Name

Last Name

Readiness Assessment: *

Please read and check ALL of the statements that apply:

I am NOT currently experiencing a physical, emotional or mental crisis that is inhibiting my ability to focus and to think positively.

My schedule allows for coaching sessions to take place during business hours (Eastern Time) Thursday and Friday.

I have computer video call capability - a device connected to the internet (ideally wired, not wifi) with the app Zoom, a camera, as well as a headset or earbuds/microphone.

Coach / Client Agreement: *

Please read and click on ALL of the statements below:

As a Client I am responsible for creating and implementing my decisions, choices, actions and results. my coach request that I aim to show up fully to the coaching and whole-heartedly commit to doing the work that needs to be done to achieve my best possible life. I will create appropriate time, energy and resources necessary while we’re working together.

I understand that coaching is a partnership where my coach and I both work together on achieving my goals. It isn’t therapy, consulting or mentoring and does not aim to prevent, cure, or treat any mental disorder or medical disease.

Schedule & Fees: We agree to coach for 1hr-sessions per every 2 weeks at $250 per hour, payable at the start of each month by e-transfer to salima@salimashamji.com. My coach request that I commits to working with her for a minimum of 6 months though I am not bound by this and can terminate at any time

If I do terminate and have prepaid my coach will return prorated fees for the remaining unused sessions minus $ 75 administrative fee.

Confidentiality: It is my Coach's commitment during my sessions, and any communication outside of my sessions, to provide an environment for me that is friendly, focused and confidential. Specific content of all coaching sessions will not be discussed with or released to any other party unless my Coach is required to do so by law. My name and contact information will be shared with the International Coach Federation (ICF) coaching faculty for auditing purposes.

Procedure: I will book a session via the scheduling link provided. Sessions are to be via ZOOM and a link will be sent to me vial email. I will initiate calls and aim to be punctual.

If I cannot make an arranged session, I am required to give two (2) business days notice before the start of that session (ie, by Wed 3pm cancel Friday’s 3pm session) If less notice is given, then the session is forfeited. In this case, a replacement session can be added on for an additional fee of $250 CDN

As a part of self-reflection development, I agree to take notes on my discoveries throughout this engagement and I will share key takeaways [in text] with my Coach after each session.

My Coach will listen carefully to my words and will ask me what route I wish to take based on what I express. My Coach may ask me to complete mutually agreed upon tasks. As the Client, I am responsible for all my personal/career growth and the actions I take throughout and beyond these coaching sessions.

In line with the International Coach Federation's core values and definition of coaching, my Coach adheres to the Code of Ethics that is designed to provide appropriate guidance, accountability and enforceable standards of conduct for all ICF credential-holders.

My coach will destroy her email communications with me, and any notes she has taken about our sessions, within one (1) month of completing this engagement. My Coach may keep my name, email address, invoice and this agreement on file for up to seven (7) years.

I understand and accept ALL of the above conditions *

I understand and accept ALL of the above conditions

Today's Date *

MM

DD

YYYY

Signed by : *

Please click the submit button after signing. A copy of this form will be emailed to you. If you do not receive it, please send Salima a note.

First Name

Last Name