Coaching Registration

Confidence Coaching – Registration

Participant Name(Required)

First Last

Date of Birth(Required)

MM slash DD slash YYYY

Parent / Guardian (Payee) Name (if under 18)

First Last

Phone(Required)

Email(Required)

Billing Address(Required)

Street Address Address Line 2 City Province Postal Code

What age group is the participant currently in?

10-12

13-15

16-18

19+

What areas of confidence or leadership are you hoping to improve the most? (Select Top 1 or 2)

Self-Confidence & Positive Self-Talk

Leadership & Communication Skills

Growth Mindset & Resilience

Managing Stress & Emotions

Decision-Making & Problem Solving

Teamwork & Collaboration

Would you like to be added to our email list to stay up to date on the latest programs?

Yes

No

Please select package(Required)

1 Tune-Up Call ($100 + GST/PST)

3 Sessions ($270 + GST/PST)

GST + PST (11%)(Required)

Price: $ 0.00 CAD

Total

Credit Card

Cardholder Name

Card Details

Δ

Contact us: +1 306-741-4217

Swift Current, SK