VIP Intake Form

Parent/Guardian Name(Required)

First Last

Relationship to Child

Phone(Required)

Email(Required)

Preferred Method of Communication(Required)

Call

Text

Child's Name(Required)

First Last

Child's Age(Required)

Child's Grade(Required)

School Attending(Required)

Hobbies/Interests

What are your main reasons for seeking coaching for your child?

What are some strengths your child possesses?

What are some challenges your child is currently facing?

What specific goals or outcomes do you hope to achieve through coaching?

Are there any past experiences (positive or negative) that may be relevant to coaching?

What approaches or strategies have worked well in supporting your child in the past?

Are there any particular concerns you have regarding your child’s mental health, motivation, self-esteem, or relationships?

How would you describe your communication and relationship with your child?

Is there anything else you’d like me to know about your child or your family dynamic that would be helpful in the coaching process?