Be Your Best Coaching Registration Form
  • Be Your Best Coaching Registration Form

    Please fil this form out carefully. If you have any questions about anything on the form or need technical help, please contact: Mira Kaye Cohen, Coach at mira@bybcoaching.net. Please note that your answers will be on a password protected computer and never shared.  You can always contact me and arrange an alternate way of getting me the information if that's better for you.
  • Basic Client Information

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  • Your Home, School, and Work Details

  • Not sure which time zone you’re in? To find out, you can enter your city or state here.

  • Basic Parent Information

    Only required if you're under 18
  • Client Coaching Needs

  • Coaching Agreement

  • All Clients Statement

  • I have reviewed and understand:

    • How coaching works
    • Potential benefits and risks of coaching
    • What services Be Your Best Coaching can and cannot offer
    • My rights as a coaching client 
    • How recordings of private sessions will be stored and used 
    • Be Your Best Coaching’s missed session and refund policy

    I agree to:

    • Attend every session on time.
    • Notify my coach about any scheduling conflicts at least two days in advance. If something unexpected occurs, I will notify the group leader as soon as possible.
    • Complete between session practice activities to the best of my ability.
  • Group Participant Agreement

  • I have reviewed and understand:

    • How BYBB Coaching Groups work
    • Potential risks and benefits of participating in groups
    • Role of my coach as the group leader 
    • My role as a group participant
    • Group communication agreement
    • Rules about sharing private information of other group members
    • How group session recordings will be stored and used

    ​​​​​​​​​​​​I have also reviewed and understand and promise to honor the sharing group safety concerns policy and group confidentiality agreement.

  • Client Signature

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  • All Parents/Guardians Statement

    Only complete if you are under age 18
    • I have reviewed and understand how coaching works.
    • I have reviewed and understand the potential risks and benefits of coaching.
    • I have reviewed and understand the role of the coach and what services Be Your Best Coaching can and cannot offer.
    • I have reviewed and understand my child’s rights.
    • I have reviewed and understand why and how private meeting recordings and transcripts will be stored and shared.
    • I have reviewed and understand Be Your Best Coaching’s missed session and refund policy. I will remind my child to attend sessions on time and notify the coach at least two days in advance if there are any scheduling conflicts. If something unexpected happens, I will remind my child to inform the coach as soon as possible.
    • I will encourage my child to participate fully in sessions and complete between session practice activities to the best of their ability.
  • Parents/Guardians of Group Participants Statement

    Only complete if you're under 18
    • I have reviewed and understand the potential risks and benefits of participating in coaching groups.
    • I have reviewed and understand the role of the group leader.
    • I have reviewed and understand the roles of participants.
    • I have reviewed and understand the rules about sharing group member’s private information.
    • I have reviewed and understand the sharing group safety concerns policy and confidentiality agreement. If my child tells me they're concerned about another group member's safety, I will share those concerns with the group leader.
    • I will encourage my child to regularly use her new skills and keep in touch with other group members between group sessions. I have reviewed the group communication agreement and will remind my child of its contents as appropriate.
  • Parent/Guardian Signature

    Only complete if you're under 18
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  • Client Strengths, Challenges, and Supports

  • The next questions can help me understand your challenges and how to support you best. Only share what you feel comfortable with.

    • Client Challenges 
    • Client Supports 
    • Should be Empty: