LEAD222 Member Registration for 12 Months of Coaching 2024-25

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Personal Information

 
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Enter Primary email you want LEAD222 to use,  where you can be reached most reliably. (Preferably your work email)
 
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Family Information

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Ministry Information

 
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Church Information

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Coaching Understanding

I have read and am in agreement with LEAD222's Statement of Faith.
I will ensure my full coaching fee is paid.
Follow this link to read our Mission, Vision, and our Statement of Faith.
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Disclaimer of Confidentiality/Release of Liability

I understand that LEAD222 is not professional counseling, and have voluntarily sought coaching and mentoring advice, encouragement and prayer on my own initiative. I am under no obligation to accept or reject any of the advice I may receive from the LEAD222 Coaching Team or staff from the LEAD222 ministry. With the intent to bind my heirs, relatives, legal representatives and assigns, I expressly release and hold harmless LEAD222 United, LTD, employees and all other persons working with them, including contract hires, on their behalf from liability, loss damage, claims, actions or judgment of any kind which may arise in connection with the advice received. All services and information obtained are kept confidential (unless otherwise specified) and cannot be released without your permission. You need to know, however, there are special situations under which confidential information could legally be revealed such as:

1. In the case of emergency where you are a danger to yourself or someone else
2. If an unreported felony has occurred
3. In special circumstances where a court may subpoena your records and order a LEAD222 Coach or staff member to give testimony in a court hearing.

By checking this box I agree that I have read this Acknowledgement Disclaimer of Confidentiality/Release of Liability and understand I have executed it as my free and voluntary act.
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Description

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