This Agreement is entered into by and between: Impel, LLC, 4005 Roberts Road Fairfax, VA 22032 and
1) Mentor-Client Relationship
A. Mentor agrees to maintain the ethics and standards of behavior established by Impel, LLC.
B. Client is solely responsible for creating and implementing his/her own physical, mental and emotional well-being, decisions, choices, actions and results arising out of or resulting from the mentoring relationship and his/her mentoring calls and interactions with the Mentor. As such, the Client agrees that the Mentor is not and will not be liable or responsible for any actions or inaction, or for any direct or indirect result of any services provided by the Mentor. Client understands mentoring is not therapy and does not substitute for therapy if needed, and does not prevent, cure, or treat any mental disorder or medical disease.
C. Client further acknowledges that he/she may terminate or discontinue the mentoring relationship at any time.
D. Client acknowledges that mentoring is a comprehensive process that may involve different areas of his or her life, including work, finances, health, relationships, education and recreation. The Client agrees that deciding how to handle these issues, incorporate mentoring principles into those areas and implementing choices is exclusively the Client’s responsibility.
E. Client acknowledges that mentoring does not involve the diagnosis or treatment of mental disorders as defined by the American Psychiatric Association and that mentoring is not to be used as a substitute for counseling, psychotherapy, psychoanalysis, mental health care, substance abuse treatment, or other professional advice by legal, medical or other qualified professionals and that it is the Client’s exclusive responsibility to seek such independent professional guidance as needed. If Client is currently under the care of a mental health professional, it is recommended that the Client promptly inform the mental health care provider of the nature and extent of the mentoring relationship agreed upon by the Client and the Mentor.
F. The Client understands that in order to enhance the mentoring relationship, the Client agrees to communicate honestly, be open to feedback and assistance and to create the time and energy to participate fully in the POWER mentoring program.
The parties agree to engage in an on-going Mentoring Program through (Positive youth development, social emotional learning, in-person, internet and telephone) meetings. Mentor will be available to Client by phone including text messages, e-mail and voicemail in between scheduled meetings as defined by the Mentor (Unlimited phone calls and text messages between the hours of 9am and 8pm Monday through Saturday and unlimited emails 7 days a week and 24 hours a day). Mentor may also be available for additional time, per Client’s request on a rate of $65.00 per hours face to face and any conversation (not face to face) that exceeds 15 minutes and up to 30 minutes will be billed at a rate of $30.00, (for example, engaging in other Client related services outside of mentoring hours). Conversations that exceed 30 minutes will be billed at a rate of $65.00 an hour.
3) Schedule and Fees
This mentoring agreement is valid as of 4/25/2021. The fee is $65.00 per 1-hour session (in person). Sessions exceeding 30 minutes will be billed at a rate of $65.00.
The meetings/sessions shall be 1 hour in length on average. The client and client’s parents may discus additional length of services if needed. Billing will be directed to parents/legal guardian.
Client’s parent may select a payment option of paying after each session or monthly. An invoice can be submitted at the end of every month as requested.
Methods of payment include credit card, check, or other electronic payment such as Venmo or Paypal.
The refund policy in effect for the term of this Agreement is as follows:
Non-Refundable, non-creditable payments. Each payment that is required under this Agreement is non-refundable and non-creditable.
The time of the Mentoring meetings/sessions and/or location will be determined by the Mentor and Client based on a mutually agreed upon time. The Client will initiate all scheduled calls and will call or text the Mentor at the following number for all scheduled meetings202-644-6812. If the Mentor will be at any other number for a scheduled call, Client will be notified prior to the scheduled appointment time.
This mentoring relationship, as well as all information (documented or verbal) that the Client shares with the Mentor as part of this relationship, is bound by the principles of confidentiality set forth in the Impel, LLC Code of Ethics. However, please be aware that the Mentor-Client relationship is not considered a legally confidential relationship (like the medical and legal professions) and thus communications are not subject to the protection of any legally recognized privilege. The Mentor agrees not to disclose any information pertaining to the Client without the Client’s written or verbal consent. The Mentor will not disclose the Client’s name as a reference without the Client’s consent.
Confidential Information does not include information that: (a) was in the Mentor’s possession prior to its being furnished by the Client; (b) is generally known to the public or in the Client’s industry; (c) is obtained by the Mentor from a third party, without breach of any obligation to the Client; (d) is independently developed by the Mentor without use of or reference to the Client’s confidential information; or (e) the Mentor is required by statute, lawfully issued subpoena, or by court order to disclose; (f) is disclosed to the Mentor and as a result of such disclosure the Mentor reasonably believes there to be an imminent or likely risk of danger or harm to the Client or others; and involves illegal activity. The Client also acknowledges his or her continuing obligation to raise any confidentiality questions or concerns with the Mentor in a timely manner.
6) Release of Information (Optional, based upon specific situation)
The Mentor engages in training and continuing education pursuing and/or maintaining Quality Mental Health Professional Credentials. Client acknowledges that a Release of Information must be signed in order to involve a third-party to enhance the quality of services being provide (examples include: School staff, coach, employer, and therapist).
7) Cancellation Policy
Client agrees that it is the Client's responsibility to notify the Mentor 24 hours in advance of the scheduled calls/meetings for any cancelations. Mentor reserves the right to bill Client for a missed scheduled meeting if 24 hour notice is not provided for cancelations or rescheduling.
8) Record Retention Policy
The Client acknowledges that the mentor has disclosed his/her record retention policy with respect to documents, information and data acquired or shared during the term of the Mentor-Client relationship. Such records will be maintained by Impel for a period of not less than 3 years.
Either the Client or the Mentor may terminate this Agreement at any time. Client agrees to compensate the Mentor for all mentoring services rendered through and including the effective date of termination of the Mentoring relationship.
10) Limited Liability
Except as expressly provided in this Agreement, the Mentor makes no guarantees, representations or warranties of any kind or nature, express or implied with respect to the mentoring services negotiated, agreed upon and rendered. In no event shall the Mentor be liable to the Client for any indirect, consequential or special damages. Notwithstanding any damages that the Client may incur, the Mentor’s entire liability under this Agreement, and the Client’s exclusive remedy, shall be limited to the amount actually paid by the Client to the mentor under this Agreement for all mentoring services rendered through and including the termination date.
11) Entire Agreement
This document reflects the entire agreement between the Mentor and the Client, and reflects a complete understanding of the parties with respect to the subject matter. This Agreement supersedes all prior written and oral representations. The Agreement may not be amended, altered or supplemented except in writing signed by both the Mentor and the Client.
12) Dispute Resolution
If a dispute arises out of this Agreement that cannot be resolved by mutual consent, the Client and Mentor agree to attempt to mediate in good faith for up to (certain amount of time such as 60 days) after notice given. If the dispute is not so resolved, and in the event of legal action, the prevailing party shall be entitled to recover attorney’s fees and court costs from the other party.
If any provision of this Agreement shall be held to be invalid or unenforceable for any reason, the remaining provisions shall continue to be valid and enforceable. If the Court finds that any provision of this Agreement is invalid or unenforceable, but that by limiting such provision it would become valid and enforceable, then such provision shall be deemed to be written, construed, and enforced as so limited.
The failure of either party to enforce any provision of this Agreement shall not be construed as a waiver or limitation of that party's right to subsequently enforce and compel strict compliance with every provision of this Agreement.
15) Applicable Law
This Agreement shall be governed and construed in accordance with the laws of the Commonwealth of Virginia, without giving effect to any conflicts of law provisions.
16) Binding Effect
This Agreement shall be binding upon the parties hereto and their respective successors and permissible assigns.
Please sign and return this Client Agreement prior to the first scheduled mentoring meeting. Retain one copy for your records and mail the other to: