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Live Anew Coaching Small Group Program
Small Groups Spring 2024
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Child's Full Name
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Child's Birthdate
MM
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DD
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YYYY
Child's Grade
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School attending
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Child's cell number
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Parent(s) name(s)
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Address
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Parent(s) cell number
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Parent(s) e-mail
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Does your child have any learning disabilities or other health impairments? (Do they have an IEP/504?)
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Dietary restrictions and allergies
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Medical information
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Any information about your child that would be helpful to know. (anxiety, ADHD, bullied, poor school performance, behavior challenges, not connecting, meets with a therapist, etc)
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What are the best things about your child and favorite things to do?
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What is your reason for registering your child for this program?
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By typing your name you have read and agree to the waivers. (Note there is a waiver for physical activities and a separate waiver for life coaching.)
The Waivers can be found here:
Waivers
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By clicking the box you agree to the waiver I agree to photos being used for marketing purposes.
I agree to the photo release
Payment is due upon regristration. $250
Venmo @amywalters2011 (red shirt in mud picture)
Zelle (704)491-4426 LIve Anew Coaching
Check (sent to 17323 Georgian Hall Dr. Charlotte, NC 28277)
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