Parent Intake Form

Completing this form allows me to get to know your child and their unique story before we meet. Your input will help create a compassionate and personalized space where your child can grow and thrive.

Please answer as fully as you feel comfortable.

DISCLAIMER

Nature of Services
Life coaching is a collaborative process designed to support personal growth, self-discovery, and goal achievement. Coaching is not therapy, counseling, medical advice, or legal advice. Coaching sessions do not diagnose or treat mental health conditions, medical concerns, or legal matters.

Responsibility
By participating in coaching, you acknowledge that you are fully responsible for your own (or your child’s) well-being, decisions, choices, and actions, both during and after coaching sessions. The coach does not guarantee specific outcomes or results.

Working With Minors
When coaching a minor, the parent or legal guardian understands and agrees that:

  • They are providing full consent for their child to participate in coaching sessions.

  • The parent/guardian remains fully responsible for all decisions, actions, and well-being of the child before, during, and after coaching sessions.

  • The coach’s role is supportive and educational, not clinical or medical.

  • The coach will maintain the child’s sense of privacy and autonomy in sessions; therefore, session content may not be shared in full with the parent unless the child consents or safety concerns require disclosure.

  • The parent/guardian agrees to communicate any relevant information (including medical, psychological, or safety-related concerns) that may impact the child’s coaching experience.

  • The coach reserves the right to discontinue coaching if it becomes apparent that coaching is not appropriate or if therapy, evaluation, or other professional services are recommended.

Limits of Liability
The coach is not liable for any direct, indirect, or incidental outcomes resulting from coaching conversations, exercises, or materials provided.

The coach is not responsible for technical issues beyond their control (such as email interception, hacking, or data breaches on third-party platforms).

The coach is not responsible for missed appointments or rescheduling delays that occur due to client error, technical difficulties, or circumstances beyond reasonable control.

Confidentiality
Coaching sessions are private and confidential. However, confidentiality may be broken if required by law (e.g., imminent harm to self or others). Digital communication (email, text, video conferencing) carries inherent risks, and absolute security cannot be guaranteed.

Client Acknowledgment
By engaging in coaching services, you confirm that:

  • You understand the nature and limits of coaching.

  • You understand and consent to the coaching of your minor child (if applicable).

  • You agree that coaching is not a substitute for professional or clinical care.

  • You release the coach from liability for your (or your child’s) decisions, actions, or outcomes.