Mission Elite Performance Inc.
[email protected] - 107 Thorp Crescent, Ajax, ON L1T 3T5 - 405 306 5501
Informed Consent
Purpose of Informed Consent Form
The purpose of this informed consent form is to set clear parameters between Mission Elite Performance Inc., and you, the “Client/Athlete” for the purpose of the mental skills coaching. Upon signing, consider this form as an agreement between us. If any questions or concerns around the form do arise, please do not hesitate to ask me.
Mental Performance Coaching
Mental performance coaches are a resource for athletes, teams, and coaches. Individual mental performance coaching is an opportunity for clients/athletes to discuss topics that relate to their performance, with common topics including building confidence, improving focus, and increasing resilience. During the course of the coaching, there could be instances where certain topics lead to feelings of frustration and/or discomfort. As well, there is no guarantee that participating in mental skills training will give you success.
Mental Performance Coaches Credentials
I, Raheel Manji, have worked with athletes and teams at various levels to help them improve on their mental performance. I have a certificate of completion in a Fully Accredited Professional Neuroplasticity Diploma Course and a Fully Accredited Professional Sport Psychology Diploma Course by Dr. Karen E Wells. I am also trained by the National Coaches Certification Program in Psychology of Performance.
Client Autonomy
We will work collaboratively to determine the direction of the mental performance training, as well as the points of discussion, the application of mental performance techniques, and the consulting goals. You have the right to not participate in part of mental performance consulting as well as the right to end the mental performance consulting relationship at any time without penalty.
Confidentiality and Limitations
The information discussed in our sessions will remain confidential with a few exceptions. I must breach confidentiality if you are an immediate danger to yourself or others. I must report the abuse of a child, or an elderly or disabled person. If the court subpoenas your records, I must provide them. If you are a dependent adult, your guardian has the right to impose a limit on your confidentiality. If any of these situations occur, or another unforeseen situation occurs where your confidentiality may/must be breached, I will make every effort to speak with you before breaking confidentiality. As well, if we are speaking in a public place there is a chance that others could overhear our conversation.
If we are meeting over the use of an online platform (ie. “Zoom”), I cannot guarantee that our conversations will be absolutely confidential due to the lack of general security of information being stored over the internet.
Informed Consent
I acknowledge that I have read and understood the information contained in the informed consent document. I consent to participate in mental performance coaching.