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Please complete the short student contact form:
Student’s Full Name
(Required)
First
Last
Student's Date of Birth
(Required)
MM slash DD slash YYYY
Student's Phone
(Required)
Student's Email
(Required)
In order for your child to get a transformation, we must focus on one issue at a time. Which issue do you want us to focus on (choose one):
(Required)
Anxiety
Stress
Low Motivation
Lack of Confidence
Poor Self Control
Body Image Issues
Poor Time Management
Poor Decision Making
Academic Problems
Parent-Teen Conflict
Failure to Excel in Sports
Concerning the issue you chose above, describe what you need to see (or hear) from your child to consider this program a success.
What is your secondary goal to prioritize for your child (choose one):
(Required)
Anxiety
Stress
Low Motivation
Lack of Confidence
Poor Self Control
Body Image Issues
Poor Time Management
Poor Decision Making
Academic Problems
Parent-Teen Conflict
Failure to Excel in Sports
Concerning the issue you chose above, describe what you need to see (or hear) from your child to consider this program a success.
Parent's Name
(Required)
First
Last
Parent's Email
(Required)
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