PUSH Academy Application
Welcome! You're here because you're ready for the next level of growth! Fill out this form with as much detail as you can, so me and my team can get to know you and strategize how we can crush your goals together. Let’s get started!
Full Name
*
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Phone Number
*
E-mail
example@example.com
Instagram and Facebook Handles
Add one or both profile handles
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How did you hear about Mesh Dollhouse
*
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Instagram
Facebook
TikTok
Magazine Feature
Family/Friend
Other
Are you interested in joining our affiliate program where you can earn commissions for referrals?
Please Select
Yes
No
Are you currently signed up with another coaching program, sisterhood or empowerment group at this time?
Please Select
Yes
No
Have you worked with a coach or mentor before? If so, what was your experience like? If not, what other approaches have you tried in the past to improve your life, and what were the results?
Be specific.
Are you okay with receiving training & coaching within a group setting?
Please Select
Yes
No
If you are not okay with group trainings/coaching please stop here as Mesh Dollhouse is not the program for you.
What goals do you want to achieve in the next 90 days?
90 Day Goal(s). Be specific.
Why do you want to join Mesh Dollhouse? And what do you expect from me and my team of Mentors-Coaches?
What are you hoping to gain from this experience? Be specific. (Ex: Sisterhood Connection, Personal Growth & Develop, Career Development, Entrepreneurial Skills)
Be real with yourself, how serious are you about improving your life?
Please Select
Somewhat serious
Serious but fearful
Serious and ready to work no matter what
How long to do anticipate being in the program?
Please Select
3 months
6 months
12 months or longer
3 months minimum required
EMERGENCY CONTACT:
Full Name
Address
Contact Number
1
2
I certify that my answers are true and complete to the best of my knowledge. I understand that as an active participant in the program if I do not represent the company in a positive and respectful manner I can be released from the coaching/mentorship program at any time. In order to have a professional and gossip free company I will: 1. Not speak or insinuate another person’s name when that person is not present unless it is to compliment or reference regarding business matters. 2. Refuse to participate when another mentions a person who is not present in a negative light. I will change the subject or tell them I have agreed not to talk about another. 3. Choose not to respond to negative emails or use emails to pass on private or derogatory information about any person in the company. 4. If another person in the company does something unethical, incorrect, against procedures, or disruptive I will use the proper channels to report this to the person to the upper management and the CEO to take corrective action. 5. I will be respectful, professional, communicate effectively, and expect the same from others.
Yes, I agree.
Mesh Dollhouse PUSH Academy:- As apart of this agreement, you agree to pay a Quarterly membership fee of $749 and commit to be in the program a minimum of 3 months. You can renew your plan for membership every 3 months and remain in the company for the length of time that you desire. However, this is contingent that you’re meeting your goals and growing personally & professionally in the company. Please note: There will be no refunds issued after payments have been received. - There will be a quarterly review to analyze your progress in the program prior to be accepted for another semester. - You are not considered an official member of Mesh Dollhouse until you successfully complete a 3 month probation period, have satisfactory progress on your quarterly review, and renew your plan for another quarter. You will have the option to opt into monthly payments of $249 if you prefer a monthly option. - You will agree and sign a contract as well to reflect the policy noted above.
Yes, I agree.
The parties agree to enter into a confidential relationship with respect to the disclosure of certain proprietary and confidential information ("Confidential Information"). 1. Definition of Confidential Information. For purposes of this Agreement, "Confidential Information" shall include all information or material that has or could have commercial value or other utility in the business in which Disclosing Party is engaged. If Confidential Information is in written form, the Disclosing Party shall label or stamp the materials with the word "Confidential" or some similar warning. If Confidential Information is transmitted orally, the Disclosing Party shall promptly provide a writing indicating that such oral communication constituted Confidential Information. 2. Exclusions from Confidential Information. Receiving Party's obligations under this Agreement do not extend to information that is: (a) publicly known at the time of disclosure or subsequently becomes publicly known through no fault of the Receiving Party; (b) discovered or created by the Receiving Party before disclosure by Disclosing Party; (c) learned by the Receiving Party through legitimate means other than from the Disclosing Party or Disclosing Party's representatives; or (d) is disclosed by Receiving Party with Disclosing Party's prior written approval. 3. Obligations of Receiving Party. Receiving Party shall hold and maintain the Confidential Information in strictest confidence for the sole and exclusive benefit of the Disclosing Party. Receiving Party shall carefully restrict access to Confidential Information to members, contractors, and third parties as is reasonably required and shall require those persons to sign nondisclosure restrictions at least as protective as those in this Agreement. Receiving Party shall not, without prior written approval of Disclosing Party, use for Receiving Party's own benefit, publish, copy, or otherwise disclose to others, or permit the use by others for their benefit or to the detriment of Disclosing Party, any Confidential Information. Receiving Party shall return to Disclosing Party any and all records, notes, and other written, printed, or tangible materials in its possession pertaining to Confidential Information immediately if Disclosing Party requests it in writing. 4. Time Periods. The nondisclosure provisions of this Agreement shall survive the termination of this Agreement and Receiving Party's duty to hold Confidential information in confidence shall remain in effect until the Confidential Information no longer qualifies as a trade secret or until Disclosing Party sends Receiving Party written notice releasing Receiving Party from this Agreement, whichever occurs first. 5. Relationships. Nothing contained in this Agreement shall be deemed to constitute either party a partner, joint venture or employee of the other party for any purpose. 6. Severability. If a court finds any provision of this Agreement invalid or unenforceable, the remainder of this Agreement shall be interpreted so as best to affect the intent of the parties. 7. Integration. This Agreement expresses the complete understanding of the parties with respect to the subject matter and supersedes all prior proposals, agreements, representations, and understandings. This Agreement may not be amended except in a writing signed by both parties. 8. Waiver. The failure to exercise any right provided in this Agreement shall not be a waiver of prior or subsequent rights. The persons checked and signed below agreeing to the following noted above.
Yes, I agree.
Please submit a clear head-shot. (no filters or black & white photos. Professional head-shot NOT required but recommended)
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