Confidence Coaching Registration Form

Thank you for your interest in our confidence coaching groups. In order to ensure the highest quality group experience we require a quick, 15 minute free consultation call with a parent or guardian of the potential group member. This brief call helps ensure that the needs of group members are a match with the goals of a particular group.
Name of parent or guardian*
First Last
Name of group member*
First Last
Email
Phone*
When is a good time for us to contact you?*
- Select All
- Morning
- Afternoon
- Evening
Which service are you interested in?*
- Virtual Individual Coaching
- Face-to-Face Individual Coaching (currently unavailable)
- Group - Girls 11-13 on Tuesdays from 6:00-7:00PM
- Group - Girls 14-16 on Tuesdays from 4:30-5:30PM
- Group - Boys 14-16 on Thursday from 4:00 - 5:00PM
Are you interested in individual or group coaching services?
Name
This field is for validation purposes and should be left unchanged.

Young Adults