Your Thoughts. Your Choices. Your Work.
WholeSelf BOUNDARIES COACHING
SELF-COACHING GROUP MEETINGS & PERSONAL COACHING SESSIONS
PARTICIPATION AGREEMENT & WAIVER
For First-Time Participants and Personal Coaching Clients
Participant Full/Legal Name: __________________________
Preferred First Name + Last Initial for Group Meetings: ________________________
Preferred Pronouns (optional): __________________________
Date: __________________________
I confirm that I am 18 years of age or older. ☐ Initials: __________
FIRST-TIME GROUP MEETING PARTICIPANTS: Your first WBC Group Meeting is complimentary! When booking your first meeting online, enter coupon code FIRSTSESSIONFREE in the coupon field at checkout to receive your complimentary first Group Meeting. (This offer does not apply to Personal Coaching sessions.
1. NATURE AND PURPOSE OF WBC GROUP MEETINGS
WholeSelf Boundaries Coaching (WBC) Group Meetings are structured, peer-supported meetings for adults exploring boundaries, communication, choices, relationships, self-patterns, and what matters to them.
WBC Group Meetings provide opportunities for self-reflection and self-coaching within a structured peer setting. Participants may speak, listen, reflect, or pass. There is no required goal, conclusion, decision, or change. Your reflections, your choices, supported by structure and peers. A boundary does not have to change in order for the exploration to have been worthwhile. ☐ Initials: __________
2. WHAT WBC GROUP MEETINGS AND PERSONAL COACHING ARE NOT
I understand that WBC Group Meetings and Personal Coaching are not:
- Psychotherapy or group therapy.
- Mental-health counseling.
- Mental-health treatment.
- Medical care.
- Mental-health diagnosis, testing, or assessment.
- Crisis intervention.
- Legal, financial, medical, psychological, or other professional advice.
- A substitute for services from an appropriately licensed professional when those services are needed.
I understand that Jaeci Carr participates in these meetings and sessions in her WBC coaching role and is not acting as my psychotherapist, counselor, medical provider, or other licensed mental-health provider. ☐ Initials: __________
3. VOLUNTARY PARTICIPATION AND RIGHT TO PASS
My participation is voluntary.
WBC does not require me to disclose anything.
I decide:
- Whether I speak.
- What I discuss.
- How much I disclose.
- Whether I answer a Boundary Awareness Question (BAQ).
- Whether I participate in a particular discussion.
- Whether I pass.
- Whether I step out of the room.
- Whether I leave the meeting.
- What meaning, if any, I take from the experience.
- Whether I make any changes afterward.
I understand that I may say “pass” at any time without explanation.
☐ Initials: __________
4. SELF-REFLECTION, SELF-COACHING AND PERSONAL RESPONSIBILITY
Questions, BAQs, meeting topics, Appreciation Statements, and comments or experiences shared by other participants are offered as opportunities for self-reflection or self-coaching, not as instructions about what I should think, feel, decide, say, or do.
I remain responsible for my own:
- Choices.
- Communications.
- Decisions.
- Boundaries.
- Relationships.
- Actions.
I understand that participation in a WBC Group Meeting or Personal Coaching session does not transfer responsibility for my decisions or actions to WBC, Jaeci Carr, or another participant. ☐ Initials: __________
5. PEER-SUPPORTED SHARE CIRCLES
I understand that the people participating at my Share Circle table are fellow participants. Participants are not present to diagnose, counsel, fix, rescue, direct, evaluate, or solve problems for one another. Information or personal experiences shared by another participant should not be treated as professional advice or instruction. Each person decides for themselves what, if anything, is useful or relevant from what they hear. ☐ Initials: __________
6. SHARE CIRCLE PARTICIPATION AGREEMENT
I agree to follow the WBC Share Circle structure, including:
- Respecting equal allotted speaking time.
- Respecting another participant's right to pass.
- Allowing the person holding the Talking Stick to have their allotted time without interruption.
- No advice-giving.
- No interpreting another participant's experience.
- No correcting another participant.
- No questioning or interrogating another participant.
- No attempting to solve another participant's problem.
- No diagnosing or labeling another participant.
- Respecting the meeting timer and transition signals.
- Following the WBC format for Appreciation Statements.
- Respecting another participant's autonomy, choices, and boundaries.
I understand that WBC Group Meetings are structured differently from ordinary conversation and agree to participate within that structure. ☐ Initials: __________
7. PRIVACY AND CONFIDENTIALITY AGREEMENT
I agree to respect the privacy of other participants.
I will not:
- Repeat another participant's personal story outside the meeting.
- Identify another participant when discussing meeting content with someone outside the meeting.
- Gossip about another participant or their disclosures.
- Photograph, audio-record, video-record, livestream, or otherwise record a WBC Group Meeting.
- Post another participant's comments, experiences, image, name, or identifying information online or on social media.
- Share written information containing another participant's personal information.
I may discuss my own experiences, reflections, insights, and choices outside the meeting. A useful guideline is: "I may share what I learned about myself. I will not share another participant's story."
I understand that WBC establishes and requires these confidentiality expectations but cannot guarantee that every participant will honor them. ☐ Initials: _________
8. PERSONAL DISCLOSURE
WBC does not require participants to disclose anything.
I decide whether I want to share personal information and how much I wish to share. I understand that participating in a Group Meeting does not require disclosure of private history, health information, trauma, diagnoses, family information, relationship information, beliefs, or other personal matters. I am responsible for deciding what I am comfortable sharing in a peer group setting.
☐ Initials: __________
9. EMOTIONAL OR PERSONAL REACTIONS
I understand that conversations about boundaries, relationships, communication, family, beliefs, choices, past experiences, and other personal subjects can sometimes bring up thoughts, feelings, memories, or reactions. If a subject does not feel appropriate for me to discuss, I may:
- Pass.
- Stop speaking.
- Decline to answer.
- Step out.
- Leave the meeting.
WBC does not provide crisis services. If I determine that I need medical, mental-health, crisis, legal, or other professional assistance, I am responsible for seeking an appropriate provider or service. ☐ Initials: __________
10. PHYSICAL CONTACT AND PERSONAL SPACE
WBC Group Meetings and Personal Coaching sessions do not include massage, bodywork, hands-on assessment, or hands-on services. I agree to respect other participants' physical boundaries and personal space. I will not initiate physical contact with another participant without that person's express permission, including hugging, touching, pats on the back, or similar physical gestures. I understand that friendliness, sympathy, appreciation, or another participant's emotional response does not constitute permission for physical contact.
☐ Initials: __________
11. RESPECTFUL AND NONDISRUPTIVE PARTICIPATION
I agree not to engage in behavior that interferes with another person's ability to participate in the meeting, including:
- Threatening or intimidating behavior.
- Harassment.
- Repeated unwanted contact.
- Deliberate disruption.
- Repeated disregard of another participant's stated boundary.
- Recording the meeting.
- Repeated refusal to follow the Share Circle structure after being asked to do so.
I understand that WBC may pause my participation, ask me to leave a meeting, or decline future participation when reasonably necessary to preserve the Group Meeting structure or the ability of others to participate. ☐ Initials: __________
12. NO GUARANTEE OF OUTCOME
I understand that WBC does not guarantee any particular outcome from attending a Group Meeting or Personal Coaching session. There is no guarantee that participation will:
- Produce a particular insight.
- Resolve a disagreement or relationship problem.
- Change another person's behavior.
- Improve a relationship.
- Lead me to change a boundary.
- Lead me to keep a boundary unchanged.
- Produce a particular personal, professional, emotional, or interpersonal result.
A WBC Group Meeting or Personal Coaching session provides an opportunity for self-reflection, self-coaching, and personal exploration. What I choose to do with that opportunity remains mine to decide. ☐ Initials: __________
13. FIRST COMPLIMENTARY GROUP MEETING AND FUTURE MEETING FEES
I understand that my first WBC Group Meeting is complimentary.
**To receive my complimentary first Group Meeting, I must enter coupon code FIRSTSESSIONFREE in the coupon field when making my online reservation.**
This coupon is intended for first-time Group Meeting participants only, is limited to one complimentary meeting per person, and does not apply to Personal Coaching sessions. If I choose to attend additional Group Meetings, the current fee is $25 per meeting.
For paid meetings:
- My payment reserves one place for the specific meeting date I select.
- If I cannot attend, I may use the WBC “Send a Friend / Replacement Policy” and send a woman friend in my place.
- My replacement must use the WBC booking link to register and must read and sign the required Participation Agreement & Waiver before participating.
- My replacement will be asked to identify whose reservation she is replacing.
- My prepaid place applies to that replacement for the originally scheduled meeting only and does not carry forward to another meeting date.
- Replacement participants MUST arrive between 1–1:30 PM.
- Doors close promptly at 1:30 PM so the meeting can begin.
There is no admittance after 1:30 PM, with no exceptions (phones are turned off at 1:30 PM, and no notifications can be received).
- If neither I nor a replacement attends the scheduled meeting, the prepaid place expires with that meeting. I understand that signing this agreement does not obligate me to attend or purchase any future meeting. ☐ Initials: __________
14. WBC MATERIALS
WBC may provide Boundary Awareness Questions, worksheets, prompts, meeting materials, or other written materials for my personal reflection and use. I may write on, retain, and use materials provided to me for my own personal purposes.
I agree not to reproduce, publish, distribute, sell, commercially exploit, or use WBC materials to conduct or facilitate another program, class, group, workshop, or commercial activity without written permission from WholeSelf Boundaries Coaching. ☐ Initials: __________
15. ASSUMPTION OF ORDINARY PARTICIPATION RISKS AND RELEASE
I understand that participation in an in-person peer Group Meeting or Personal Coaching session involves ordinary risks associated with attending an in-person gathering or appointment, including ordinary risks associated with entering, leaving, sitting, standing, or moving within the meeting space and voluntarily discussing personal subjects. To the fullest extent permitted by Colorado law, I voluntarily assume the ordinary risks inherent in my participation. To the fullest extent permitted by Colorado law, I release and hold harmless WholeSelf Boundaries Coaching, Jaeci Carr or Doctor's Care from claims arising from ordinary risks inherent in my voluntary participation, except to the extent that a claim cannot legally be released or waived. Nothing in this agreement is intended to waive rights or claims that cannot lawfully be waived under Colorado law.
☐ Initials: __________
16. ACKNOWLEDGMENT AND AGREEMENT
By signing below, I acknowledge that:
- I have read this Participant Agreement & Waiver.
- I have had an opportunity to ask questions before signing.
- I understand the nature and limits of WBC Group Meetings and Personal Coaching sessions.
- I understand that participation is voluntary.
- I understand that I may pass or discontinue participation.
- I understand that I remain responsible for my own choices and actions.
- I agree to follow the WBC Group Meeting and Share Circle guidelines when attending Group Meetings.
- I understand and voluntarily agree to the terms of this document.
☐ Initials: __________
17. PERSONAL COACHING SESSIONS
In addition to peer-supported Group Meetings, WholeSelf Boundaries Coaching offers individual Personal Coaching sessions. Personal Coaching provides one-on-one opportunities to explore personal goals, boundaries, communication, relationships, recurring patterns, choices, and other areas of life that I wish to examine.
I understand and agree that:
- Personal Coaching is a collaborative, nonclinical service intended to support my own reflection, self-awareness, decision-making, and personal goals.
- I determine the subjects I wish to explore and the goals, if any, I wish to pursue.
- Coaching questions, observations, suggestions, and exercises are offered for my consideration, not as directions I am required to follow.
- I am free to disagree, decline a suggestion, change a goal, or choose not to take action.
- Personal Coaching is not psychotherapy, mental-health counseling, medical treatment, crisis intervention, or professional legal or financial advice.
- I remain solely responsible for my decisions, boundaries, relationships, communications, and actions.
- Personal Coaching does not guarantee particular outcomes, improvements, or changes.
- I may discontinue Personal Coaching at my discretion, subject to any applicable booking, payment, or cancellation terms disclosed when I schedule a session.
- Personal Coaching sessions may be held in person or by telephone, as arranged when booking.
- Information shared in Personal Coaching will be treated with professional discretion, subject to applicable law, safety considerations, and any necessary operational disclosures. Personal Coaching is not a legally privileged therapeutic relationship, and absolute confidentiality cannot be guaranteed. I understand that the complimentary first Group Meeting coupon does not apply to Personal Coaching, which is a separately booked and priced service. ☐ Initials: __________
PARTICIPANT SIGNATURE
I have read and understand this Participation Agreement & Waiver and agree to participate under these terms.
Participant Full/Legal/Printed Name: __________________________
Participant Signature: __________________________
Date: __________________________
WholeSelf Boundaries Coaching
Support for your goals, your choices, your process — on your terms, your timeline.