Please fill out the Enrollment Form below answering all the questions. You can save money by signing up for a one-time payment of $297 or sign up for our 3 month payment plan of $110.00 a month. If you need to set up different payments, please contact me via email to see what we can work out.
If you have any questions, you can reach me at firstname.lastname@example.org.
By signing and submitting this form, I understand that I am agreeing to participate in a life coaching program through Anne Sayers and Anne Sayers.com that is not counseling, psychotherapy, psychoanalysis, mental health care or substance abuse treatment or a replacement for such. All services provided or received are provided "as is," without warranty, either expressed or implied. I understand that the programs or services provided may involve emotional release and/or physical, emotional or mental exertion, and behavioral experimentation which may cause physical, mental or emotional injury. I fully acknowledge and take full responsibility for all the risks involved and understand it is my responsibility to consult with my health care providers prior to participating. I accept full responsibility waiving all rights to liability or any claims against Anne Sayers, Anne Sayers.com or any of its agents, administrators, or employees. I forever release, waive, discharge and covenant not to sue Anne Sayers and Anne Sayers.com or ASA Inc. for any
injury, harm or death caused by either negligence or other acts.
Confidentiality: All information I divulge in this or other programs will be held as confidential unless the client states otherwise in writing or an emergency or legal demand requires otherwise.