Las Vegas Spiritual Life Coach Jaclyn Costello

Parent/Guardian Consent Form

  • Contact & Background

  • A Bit About You

  • Your Goals

  • Expectations about Coaching

  • Cancellation Policy

    Appointment times are valuable and irreplaceable. Please arrive (or be at your phone) promptly to obtain your full session. If you need to reschedule, please let me know two days in advance. I prepare and set aside time devoted exclusively for you, so unless cancelled 48 hours in advance, you are financially responsible for the time reserved. The same policy applies to prepaid success packages. If you must reschedule an appointment due to an emergency, notify me as soon as possible. Thank you for your consideration.
  • Confidentiality

    Your information, correspondence, and our private conversations will always remain 100% confidential and safely guarded. You have a right to be allowed access to any written record I have about you; though I will not release any information to anyone without a written authorization from you, except as provided for by law.
  • Your Parent or Guardian May Begin Reading Here!

    —The following section is for your parent or legal guardian to sign. The cancellation policy will also be re-printed there, for he/she to read. Thank you.
  • Parent/Guardian Consent and Release

    By typing my name in the box below, I declare the following: I understand that the minor for whom I am legal guardian will be receiving information from Jaclyn Costello and EnlightenLifeCoach.com. I understand that Jaclyn Costello is not a licensed health care practitioner and that the information my minor will be receiving is not legal, therapeutic or personal advice and cannot be considered as such. This information cannot replace or substitute for the services of trained professionals in any field including, but not limited to, psychological, financial, medical or legal. I understand that my minor should consult a medical professional concerning any symptoms that may require medical attention. I also promise to disclose to Jaclyn Costello any prior or existing or mental health conditions relating to my minor. I further release both Jaclyn Costello and EnlightenLifeCoach.com from being held liable in any manner whatsoever stemming from my minor’s use of the information he/she will be learning, including, but not limited to, injury, illness, economic loss, harmful effects, emotional distress or death. I assume full responsibility for the consequences of my minor’s decisions and actions. I have also read the Terms and Agreement pages on the EnlightenLifeCoach.com website, and I agree to the terms outlined there. I declare that I have read this consent and release, and that I fully understand and agree to its terms. Check here to confirm you accept these terms.
  • Cancellation Policy

    Appointment times are valuable and irreplaceable. Please arrive (or be at your phone) promptly to obtain your full session. If you need to reschedule, please let me know two days in advance. I prepare and set aside time devoted exclusively for you, so unless cancelled 48 hours in advance, you are financially responsible for the time reserved. The same policy applies to prepaid success packages. If you must reschedule an appointment due to an emergency, notify me as soon as possible. Thank you for your consideration.
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