Parent Permission & Registration Form for ExecYou Coach Programs 🌟🌈

Parent Permission & Registration Form for ExecYou Coach Programs 🌟🌈

Please complete this form to register your child and grant necessary permissions for coaching sessions, recordings, and media sharing.
Program Description: ExecYou Coach Kids and ExecYou Coach Junior are built around four key pillars:

Mindset & Thoughts: Recognize the “bully in the brain” (negative self-talk), build internal confidence to show up in social settings, and learn to challenge and replace unhelpful thoughts.

Self-Perception & Confidence: Explore personal strengths and talents, practice being present and comfortable in group settings, and build self-esteem and a positive sense of self.

Handling Bullying & Peer Pressure: Identify bullying and social pressure situations, learn strategies to respond effectively and safely, and practice empathy, problem-solving, and resilience in social situations.

Assertiveness & Speaking Up: Express thoughts, feelings, and boundaries respectfully, practice joining group discussions and speaking in front of peers, and build courage to stand up for themselves and others.
Participants will take part independently, and parents may wait in the designated waiting area to support a focused coaching environment.
ExecYou Coach Junior (Ages 13–16)ExecYou Coach Kids (Ages 8-12)
Child's Full Name*

First NameLast Name
Child's Age*
Parent/Guardian Full Name*

First NameLast Name
Parent/Guardian Email*
example@example.com
Once the registration form is submitted, an invoice will be sent to the email provided. Please double-check that your email address is correct.
Parent/Guardian Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Please provide one additional emergency contact in addition to the primary parent/guardian. This contact will be used if the primary parent/guardian cannot be reached in an emergency.
Emergency Contact 1 Full Name*

First NameLast Name
Emergency Contact 1 Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Children may be offered water during program sessions as needed for comfort and hydration. By completing this form, I acknowledge and give permission for staff to provide water to my child during the program, and I understand this is offered only as a routine supportive measure.
Submitting this form does not guarantee registration. A spot is reserved only after full payment is received. This form applies to both group and individual coaching sessions.
Payment is nonrefundable. If a session is missed, we will do our best to accommodate one additional time in an available slot in the near future; however, if more than one session is missed, that credit cannot be applied to a future session and a new payment will be required.
Our coaching programs are not a substitute for professional counseling or mental health treatment. If your child is experiencing mental health concerns, please seek support from a qualified professional. Although some of our coaches may also be licensed professionals, they are not providing services in that capacity during coaching sessions.

Parent Permission & Registration Form for ExecYou Coach Programs 🌟🌈

Acknowledgment & Signature