The Blueprint for Your Future Workshop | Program Registration Form

To register for an upcoming course or program, please complete the form below.

UPCOMING COURSES & PROGRAMS

The Blueprint for Your Future Workshop

The Blueprint for Your Future Workshop is a 6-week journey for young adults (grades 9-12) who are ready to gain clarity and direction in their lives. This experience helps participants strengthen self-awareness, build confidence, and develop a meaningful plan for their future. It’s designed to meet individuals where they are and guide them toward a more focused, intentional path forward.

REGISTRATION ENDS SEPTEMBER 25!

Workshop Fee
$159 Per Student
$209 Per 2 Students

Team up and save: Add a second student for only $50 more!

*Includes one workbook per participant*

*This is a one-time fee covering all 6 sessions*

SAME GREAT WORKSHOP | TWO WAYS TO BUILD YOUR FUTURE

6 Sessions - 1 Per Week
6:00pm - 7:00pm

** CHOOSE YOUR FORMAT **

IN-PERSON WORKSHOP
Mondays Beginning October 5
@ Swanston Community Center

VIRTUAL WORKSHOP
Fridays Beginning October 9
Live via Zoom

Choose your primary track below.
Monday in-person participants who miss a session are welcome
to join Friday's virtual class as a makeup option.

Friday Zoom participants cannot attend on-site.

Choose the option that works best for you.

CONTACT INFORMATION
Participant's Information

Participant's Full Name

First NameLast Name

Age

Grade Level

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

School Name

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

ADDITIONAL PARTICIPANT

If there is another participant joining, please provide their information below.

Do you have another teen to register for the workshop

2nd Participant's Full Name

First NameLast Name

Age

Grade Level

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

School Name

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

CONTACT INFORMATION
Parent/Guardian's Information

Parent/Guardian's Full Name

First NameLast Name

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Email Address

example@example.com

Relationship to Participant(s)

example@example.com

MEDICAL INFORMATION

Does your teen have any known allergies

If yes, list them below.

Type 'N/A' if there are no allergies.

Please include any other medical notes regarding your teen(s).

EMERGENCY CONTACT & PICK-UP AUTHORIZATION

Emergency Contact Name

First NameLast Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

PICK-UP AUTHORIZATION The following person(s) are authorized for pick-up:

Type 'N/A' if there are no allergies.

MEDIA CONSENT & RELEASE

I give permission for NiQ Life Coaching to take and use photos or videos of my child for promotional or educational purposes (such as social media, website, or newsletters).

I understand that I will not receive any monetary compensation for the use of these images.

I grant NiQ Life Coaching the right to edit, publish, or distribute these photos for any lawful purpose.

I understand I can revoke this consent at any time by providing written notice to the program facilitator.

PROGRAM AGREEMENT
The Blueprint for Your Future Workshop
______________________________________________________________

Program Duration
This program will run for a total of 6 weeks. Each session is intentionally structured to build on previous sessions, supporting personal growth and development throughout the experience.

Days/Times
Sessions will take place weekly on Mondays and Fridays from 6:00pm-7:00pm. Monday sessions will take place on-site at the Swanston Community Center. Friday sessions will take place virtually via Zoom. Each session will last approximately one hour. Participants are encouraged to arrive on time to fully engage in each session.

Attendance Expectations
Participants are encouraged to attend all sessions, as each week builds upon the last. Consistency will enhance the overall experience and outcomes.

If a session must be missed, participants are asked to notify in advance via email or text.

Monday Participants: Monday in-person participants who miss a session are welcome to join Friday's virtual class as a makeup option. Contact the facilitator to let them know if you plan to join for Friday's virtual session.

Friday Participants: While Friday sessions are not repeated, the facilitator will be available up to 15 minutes before each session for brief support or questions regarding missed content. Participants may also reach out via email for additional guidance.

Behavior Expectations
Participants are expected to:

~ Engage respectfully with the facilitator and other participants
~ Be present and actively participate in discussions and activities
~ Minimize distractions, including phone use during sessions
~ Contribute to a positive, supportive, and growth-focused environment

Late Registration & Fast-Track Policy
Fast-Track Makeup (Absences): Current students who miss a weekly workshop can book a 1-hour Fast-Track session with Coach NiQ to catch up on missed weeks. The makeup fee is $50 per session.

Late Registration Onboarding: New participants can register late through Week 2 (missing Session 1 and 2 only). Late registrations require standard tuition plus a $100 Fast-Track Onboarding Fee, which covers a dedicated catch-up session for the weeks missed to bring your student up to speed. The one-on-one session(s) will be scheduled at a time that works best for both your student and the facilitator.

Waiting List Cutoff: Anyone attempting to register after Week 2 will automatically be placed on the waiting list for the next cohort.

Payment Terms
Full payment is required prior to the start of the program to confirm enrollment. Space is limited and will be reserved only upon receipt of payment.

No Refund Policy
All payments are non-refundable once the program has begun, due to the limited enrollment and commitment required for the full experience.

Liability Waiver
By enrolling in this program, participants acknowledge that they are voluntarily engaging in personal development activities. The facilitator and hosting facility are not liable for any injuries, losses, or damages that may occur during participation.

Acknowledgment
I, the undersigned, acknowledge that I have read and understand the terms and expectations outlined in this agreement for The Blueprint for Your Future Workshop. I agree to the program policies, including payment terms, attendance expectations, behavior guidelines, and the no refund policy.

I understand that my participation is voluntary and that I am responsible for my own engagement and progress throughout the program. I also acknowledge and accept the liability waiver.

Parent/Guardian's Signature

Today's Date

Date

Participant's Signature

Date

2nd Participant's Signature

Date

How did you hear about us?

ALMOST DONE!

Thank you for completing the registration form. Now that your details are filled out, the final step is to submit your registration fee.

Click the "Submit & Pay" button below to save your details. A confirmation email with your secure payment links, then a welcome email with workshop information will hit your inbox shortly after!

Please send your questions or concerns to taniqua@coachniqspeaks.com.