650.648.3719 info@coachlain.com

INFORMATION FORM

Coach Lain LLC  |  Updated 09/01/2020

**THIS COMPLETED FORM IS REQUIRED (ALONG WITH YOUR PAYMENT) BEFORE YOUR BOOKING CAN BE CONFIRMED**

If you’re booking a Skills Review, a high-resolution video of you performing your skill is REQUIRED in order for Coach Lain to complete your review. If you’re booking a Mental Performance Coaching session, uploading a video is OPTIONAL.

For easy upload and download, try to keep your videos under 500MB. Please NO 4K VIDEOS (1080p is high enough).

MAKE SURE TO LABEL YOUR VIDEO FILE WITH YOUR FULL NAME so that Coach Lain can easily identify which video is yours. If you have multiple videos, please make sure that all videos are clearly labeled with your name and either “1, 2, 3, etc.” or “A, B, C, etc”.

If you have any questions, please email info@coachlain.com.

Getting Started

Following Up on a Recommendation?

Were you recommended by anyone? If so, enter their first and last names below!
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Physical Performance

What skill or issue would you like to focus on for your lesson? What led you to book this lesson in the first place?

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What about this skill do you feel your struggle with the most? What would you like to fix about your skill?

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Use Google Drive or another cloud hosting service to share the links to your video(s).

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Mental Performance

When trying to perform your skill (or just perform altogether), what do you feel you struggle with mentally? How does that make you feel emotionally?

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What steps, if any, have you already taken to try and help with this issue?

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What do you believe could have triggered this?

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I. Contact Info

Please fill out all of the information below as completely as possible.
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III. Release of Liability

**Please read carefully and sign the waiver form. Participation is not allowed until the waiver is signed.**

Undersigned Minor or Athletes (18+ yrs.) Consent
I, {athlete_first_name} {athlete_last_name}, (henceforth "Undersigned") despite all reasonable precautions implemented for safety, am fully aware of and appreciate the risks, including the risk of catastrophic injury, paralysis and even death, as well as other damages and losses associated with participation in the programs or activities. I knowingly and willingly assume all such risks and hold harmless Coach Lain Lee, III and any coaches/assistants under his employ. Consequently, I hereby for myself, heirs, executors and administrators, do waive and release any and all rights and claims for damages against the owners, operators, coaches and members of Coach Lain LLC from personal injury or accident of any sort or nature suffered by me, the undersigned, by reason of participation or membership in classes, lessons or any programs or activities of Coach Lain LLC.

Undersigned Minor / Athlete (18+ yrs.) Signature

On desktop or laptop, simply "click & draw" your signature. On mobile, simply use your finger to sign!
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Parent / Legal Guardian Consent

I, {parent_first_name} {parent_last_name}, understand the nature of these activities and the minor’s experience and capabilities and believe the minor to be qualified, in good health, and in proper physical condition to participate in such activity.

I hereby release, discharge, covenant not to sue, and agree to indemnify and save and hold harmless each of the releases from all liability claims, demands, losses, or damages on the minor’s account caused or alleged to be caused, in whole or in part by the negligent rescue operations. I further agree that if, despite this release, I, the minor, or anyone on the minor’s behalf makes a claim against any of the releases named above, I will indemnify, save, and hold harmless each of the releases from any litigation expenses, attorney fees, loss liability, damage, or cost that may incur as the result of any such claim.

I hereby give my consent for a physical examination to be administered by a physician, nurse, or other qualified medical personnel, including any applicable tests or treatment deemed necessary.

I hereby give my consent, in case the participant is injured or becomes ill, for the school, its representative, or program representative, to secure medical aid and ambulance transportation, and for the medical agency to render treatment. Payment for services shall be the responsibility of the participant, parent, or guardian.

I hereby give my consent to the team physician, emergency doctor, nurse, athletic trainer, and/or coach in charge of instruction to apply first aid treatment until the family doctor can be contacted.

I am aware that individual and group publicity photos and videos are taken from time to time and in consideration for me or my child(ren)’s participation I hereby grant my permission for my child’s likeness to be used in Coach Lain LLC publicity or advertising.

I/WE HAVE READ THE FOREGOING AND UNDERSTAND THAT ITS TERMS INCLUDE MY/OUR CONSENT AND MY/OUR AGREEMENT TO TAKE CERTAIN ACTIONS, TO ASSUME CERTAIN RESPONSIBILITIES AND TO RELEASE COACH LAIN LEE, III AND ANY COACHES/ASSISTANTS UNDER HIS EMPLOY FROM CERTAIN LIABILITIES. I/WE SIGN IT VOLUNTARILY WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.

IV. Photo / Publicity Release


I, {parent_first_name} {parent_last_name}, hereby grant Coach Lain LLC and its successors, the unrestricted right to use the undersigned’s name, likeness or appearance in any social media posts or promotional materials (printed or digital) in any form in order to promote Coach Lain LLC and its services. The undersigned expressly release and waive any demand, action and claim, license, royalty or another form of payment the undersigned, and his/her agents, representatives or assigns may have based on claims of privacy, publicity, notoriety or any other rights arising out of or related to any use by Coach Lain LLC of the undersigned’s name, likeness, or appearance.

Parent / Legal Guardian Signature

On desktop or laptop, simply "click & draw" your signature. On mobile, simply use your finger to sign!
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Please be sure to double check all of your entries and make certain you've signed and dated all sections above.

If you have any questions regarding this form, please do not hesitate to contact us at info@coachlain.com .

We look forward to working with your athlete!

Cheers!

Coach Lain, LLC | e: info@coachlain.com | p: 650.648.3719

© 2020 Coach Lain LLC. | All Rights Reserved.

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