• Rebecca's Daughters Youth Life Coaching Registration Form

    Fill out the form carefully for registration
  • Rebecca's Daughter's Youth Life Coaching Program is designed to give youth and young adults ages 10 to 24 a sense of belonging, visibility, and a platform for their voices to be heard through weekly coaching sessions and workshops. These sessions will have a social emotional learning environment that will pose questions that encourage deep reflection and recognition of the areas in adolescents lives that require the most attention:

    Assist them in identifying their motivating factors (MOFA) for making desired changes.

     Guide them to create actionable steps and devise small, weekly action plans. These steps will advance them toward the results they wish to see in school , home, and other aspects of their lives with which they are dissatisfied.

    Educate them about anchors, which are personal tools they can create to stay focused and remember to perform their weekly action steps.

    Assist with homework assignments, and enhance their math, reading, Science and writing skills through hands-on games and Implement programs such as Khan academy. 

    We will teach your adolescent stress and anxiety reduction exercises, along with breathing techniques that can shift them from a fight-or-flight response to a calm, restorative state within two minutes.

    Introduce youth to different trades and life skill opportunities through community partners and field trips to such places like local farms, universities for college visits, our local downtown market for culinary and nutrition education, trade school exposure and other methods of exposures such as expert presentations and demonstrations. 

    Additionly, we offer free private crisis life coaching sessions online and in home services 12 hours a day for adolescents experiencing drama or suffering with anxiety,  depression,  Or, for adolescents who have lost their way and may be dealing with rebellion.

     

     

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Emergency Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Informed Consent and

    Acknowledgement 

     

    I hereby give my approval for my child's participation in the Rebecca's Daughters youth Life Coaching Program  prepared by Rebecca's Daughters in exchange for the acceptance of said child's candidacy by Rebecca's Daughters. I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Rebecca's Daughters and all its respective officers agents, and representatives from any and all liability for injuries to said child arising out of participating in workshops, games, or food.

    In case of injury to said child, I hereby waive all claims against Rebecca's Daughters including volunteers, coaches , montors, and affiliates, all participants, sponsoring agencies, advertisers and, if applicable, owners and lessors of premises used to conduct the event. 

     

    Medical Release  and Authorization

    As Parent and/or Guardian of the named participant, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor's life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. 

    Permission is also granted to Rebecca's Daughters and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child's admission to the medical facility Release authorized on the dates and/or duration of the registered workshop. This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

     


    Consent for Photography and Marketing Usage


    As the Participant, Parent, and/or Gaurdian of the named participant, I hereby grant permission to Rebecca's Daughters and its affiliates to photograph, film, or otherwise capture my likeness, as well as that of my child, during the Job interview Preparation Workshop Series events and activities. I understand that these photographs and/or videos may be used for marketing and promotional purposes, including but not limited to: social media posts, website content printed materials, and advertisements. I acknowledge that my participation is voluntary and that I will not receive compensation for the use of my likeness. I waive any right to inspect or approve the finished product and any accompanying written or electronic copy that may be used in connection with it. I release Rebecca's Daughters, its representatives, coaches, mentors, and all persons acting under its permission or authority from any liability related to the use of the photographs/videos as described herein. I understand that once my image is posted on the internet, it may be downloaded by any computer user worldwide. Therefore, I agree to indemnify and hold harmless Rebecca's Daughters from any claims arising out of the use of the photographs/videos this consent is valid indefinitely from the date signed below.


    Confirmation

    BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

     

  • Date*
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