Healing Chics Global Coaching Intake

Name

First NameLast Name

Age

Date of Birth

Date

MaleFemale

Phone Number

Format: (000) 000-0000.

Email

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

SingleMarriedDivorcedWidowed

What are your personal spiritual goals?

What are your personal professional goals?

What changes would you like to make in your life right now?

Do you honestly feel like you’re walking in your purpose? Would you like help in finding your purpose?

What are the things that makes you happy?

What is your motivation in life?

What are you willing to do to achieve your goals?

What are your professional strengths and assets?

What are your expectations for this coaching experience?

AGREEMENT/REMINDERS:

I understand that all information I entered in this form will be considered strictly confidential.

The data gathered from this form will only be used as a basis for the type of coaching the client will need.

I understand that in order to be successful, it is vital to follow the plan agreed by both the life coach and the client.

Signature

Payment Method

YesNo

My Products

1:1 Coaching Session

You will pay your $50.00 Non Refundable Fee.

This fee is for a 1:1 ONLY

$50.00 Quantity

Zumba Dance Fitness

You will pay your $20.00 Non Refundable Fee.

$20.00 Quantity

Healing Chics Global ‘s Group Coaching Program

You will pay your $75.00 Non Refundable Fee.

This fee pays for the entire 3 week course

$75.00 Quantity

“The Curse of Toiling”

Starting every September 22nd of every year Coach Kyreema Hairston will be opening a coaching conference call for 75 individuals who are tired! Tired of not walking in their purpose! Tired of going through the same cycles! Tired of feeling drained! Tired of not being to pour into self and those you love! For 75 days Coach Kyreema Hairston will be coaching/speaking/teaching for two days a week about the Curse of Toiling and how we must renounce this off of our lives! We must walk into the abundant life that was promised! Are you ready to get poured into for 75 days!!! 75 spots are available!!!

$75.00

Coach Ky’s Hand made products!

Coach has made these products herself!

Lip gloss: $12.00

Body oil : $12.00

Scented Body Shea Butter : $25.00

Coaches variety soaps: $12.00 each

Body Mist :$15.00

All products which includes shipping fee

$80.00

Product Name

Healing Chics Dance Team!

$ Free Quantity

Total

$0.00