Christian Transitions

Still Waters Coaching Services

P.O. Box 5734

De Pere WI 54115

Dear New Coaching Client;

I look forward to the opportunity to get acquainted with you. I have important information for you to fill out and return to me which will enable me to obtain a brief overview of who you are, the reason you are seeking out a coaching experience and some of your goals for coaching.

Please complete these two forms--the third is optional-- and return them to me. It would also be helpful to contact me by telephone to schedule a “get acquainted” conversation!

You may mail them by postal service or e-mail the completed forms.

1) Client Profile and Contact Information

2) Coaching Agreement

Which includes payment arrangements, office policies, general client information and our confidentiality agreement.

3) Pillars of a Balanced Life Initial Evaluation Tool -- OPTIONAL

The Call Focus Form

This form will be found at the bottom of this page and is to be photocopied for your regular use prior to each session. Please mail or email this completed form to me on the day of your session so that it can be reviewed prior to your call.

I am really looking forward to coaching you as you move forward toward your dreams and aspirations; finding grace and most importantly helping you discover our God’s plan for your life and ministry.

In Service to our Messiah,

Barbara L. Klika, MSW, Personal Life Coach

Still Waters Inc. of Green Bay

info@set-apart-ministries.org

COACHING SERVICE PLAN

CLIENT NAME: DATE:

_______________________________ _________________________

Open Access Coaching:

This includes three-45 minute (or two-60 minute) session per month as well as email communication as needed and “quick check” phone calls between meetings. These calls allow you to ask for an objective viewpoint or be proactive in a situation rather than waiting to react. My goal is to respond to your email or telephone contacts within 24 hours.

I offer a complimentary session to allow you to find out what our coaching can do for you. It often takes a period of time before you begin to see and feel the benefits of coaching, thus I ask for a three-month commitment. Payments are made on a monthly basis, due on the first day of each month of the contract.

The fee for this service is $100 per month on a month-to-month basis. At any time, advance payment of a three- or six-month commitment for this service would allow us to offer you a 10% discount.

Negotiate Custom Services:

I am always happy to discuss your particular needs and custom design a coaching plan to meet them. Fees are negotiable depending on frequency and duration of scheduled sessions.

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THE COACHING AGREEMENT

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Welcome to Still Waters Inc. of Green Bay Coaching Service. This document and attachments constitute a contract between us (the "Agreement"). You should read it carefully and raise any questions and concerns that you have before you sign it.

Services:

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The services provided by Still Waters Inc. of Green Bay Coaching Services include Coaching in office or TeleCoaching on topics decided jointly with you. The purpose of coaching is to develop and implement strategies to help you reach personally identified goals of enhanced performance and personal satisfaction. Coaching may address a wide variety of goals including specific personal projects, spiritual growth, life balance, job performance and satisfaction, or transitions in your life, business, or profession.

Payment Procedure:

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Coaching fees are described on the attachment, "Coaching Fee Plan". Please sign the Plan, and include it with this Agreement.

The first coaching session will begin after this agreement is signed and returned, and the first payment is received by check.

Feedback:

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If, at any time, you feel that your needs are not being met or you are not getting what you want out of the coaching or training group, please tell me, so we can discuss your needs and adjust your coaching program, as needed. We will continue to work on the goals that you define unless you want to stop, which we will do whenever you ask.

Session Time:

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Coaching is scheduled at the mutual convenience of the Coach and the Client. The day and time for the next call will be scheduled at the close of each coaching session. Keeping a regular time for session to session is generally the most productive format.

Call Procedure:

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You will call Barb at the pre-arranged time and telephone number as scheduled, and pay the telephone charges for the call. For group coaching calls and classes, she will pay for the teleconference line, and the Clients will pay for the call into the conference line.

Cancellations:

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Please remember that you must give 24 hours prior notice if you need to cancel or change the time of an appointment, otherwise you will be charged for the session in full. Barb will make reasonable efforts to reschedule sessions, which are cancelled in a timely manner.

Termination:

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Either party may end the coaching relationship by providing the other party with a one-week written notice, which may be transmitted by email or mail.

Confidentiality:

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Confidentiality of the communications with my clients is ensured. I will only release information about our work to others with your written permission, or if I am required to do so by a court order. There are some situations in which I am legally obligated to breach your confidentiality in order to protect others from harm, including (1) if I have information that indicates that a child or elderly or disabled person is being abused, I must report that to the appropriate state agency and (2) if a client is an imminent risk to him/herself or makes threats of imminent violence against another person, I am required to take protective actions. These situations rarely occur in coaching practices, but if such a situation does occur, I will make every effort to discuss it with you before taking any action.

Some sessions are conducted in groups, including teleconference groups. You agree to maintain the confidentiality of all information communicated to you by other coaching clients and by your Coach. We also understand that progress is often enhanced when clients discuss their coaching relationship with trusted colleagues and friends. You can have these discussions, but you are expected to be very careful not to share any information, which would allow others in the group to be identified. One way to decide how and what to discuss is to think about how you would feel if someone else in the group was discussing you.

As you are probably aware, it is impossible to protect the confidentiality of information, which is transmitted electronically. This is particularly true of E-mail and information stored on computers connected to the internet (unless you use encryption and other forms of security protection), and if you use a cordless or cell phone, someone with a scanner could hear you talk.

Mutual Nondisclosure

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The Coach and Client mutually recognize that they may discuss future plans, business affairs, customer lists, financial information, job information, goals, personal information, and other private information. Barb will not voluntarily communicate the Client's information to a third party. In order to honor and protect her intellectual and professional copyrights, the Client likewise agrees to give appropriate credit as needed if discussing the coaching process.

Dispute Resolution

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Any controversy or claim arising out of or relating to this agreement, or the breach of this agreement, shall be settled by arbitration, which will occur via telephone by an arbitrator

that we mutually agree upon. The costs of the arbitration shall be shared equally.

Your signature below indicates that you have read the information in this document ("Coaching Agreement and Informed Consent) and the Coaching Service Plan,

and agree to abide by its terms during our professional Coaching relationship.

Client__________________________________ Date ____________

Coach_________________________________ Date ____________

Barbara L. Klika, MSW, Personal Life Coach

Still Waters Inc. of Green Bay

P.O. Box 5734

De Pere, WI 54115

Phone: 920-336-7005

Email: info@set-apart-ministries.org

Web Site: www.christian-transitions.com

CLIENT PROFILE

Date Prepared ______________

Name: _________________________________________________________________

Mailing Address:________________________________________________________

City/State: __________________________________Zip: _____________

Day Phone: ____________________ Day Phone: ______________________

Evening Phone: ____________________ Cell Phone: ______________________

Voice Mail: ____________________ Fax Line: ______________________

Pager: ____________________

E-mail Address ________________________________________

Date of Birth: ____________________

Occupation: ____________________________________________________________

Business Position: _______________________________________________

Marital Status: ( )First Marriage ( )Second Marriage ( )Widowed/Divorced ( )Other

Name of Spouse: _________________________________________

Children Living at Home: __________________________________________________________

Children Living outside Home: ______________________________________________________

_____________________________________________________

Brief Personal Statement of Faith: ____________________________________________________

_____________________ __________________________________________________________

______________________ _________________________________________ ________________

Milestone Events in Your Life: ______________________________ __________________________

________________________________________________________________________________

90-DAY GOALS

What are the three to five goals you want to set for yourself for the next 90 days?

1. ________________________________________________________________

__________________________________________________________________

2. ________________________________________________________________

__________________________________________________________________

3. ________________________________________________________________

__________________________________________________________________

4. ________________________________________________________________

__________________________________________________________________

5. ________________________________________________________________

__________________________________________________________________

GOALS TO REACH IN THE NEXT YEAR

What are your most important goals for the next year?

Date: ________________________