• First Name *:
  • Last Name *:
  • Email *:
  • What is the best phone number to reach you? *:
  • What time zone are you in? *:
  • Why are you interested in this opportunity to become a conscious co-parenting coach? *:
  • How many children do you have and what are their ages? (It is not necessary to be a parent.) *:
  • What is your greatest challenge with your own child(ren)? :
  • What are the obstacles keeping you from having the relationship you want with your child(ren)? :
  • Tell us about your favorite parts of parenting, or if you're not a parent, of being around children. *:
  • What are your favorite parenting books? *:
  • Do you have any experience as a coach, teacher or counselor? Describe. (OK if you don't have.) *:
  • Please share with us if you are currently working outside of the home or a full-time parent. *:
  • Why are you interested in starting your own business? *:
  • Tell us about your strengths and your best qualities. *:
  • Have you ever owned your own business? If yes, describe the business and your results. *:
  • Are you now presently, or have you ever been invested in any business development programs? *:
  • Have you gone through a high conflict divorce or custody battle? (If not, OK.) *:
  • If yes, how did you solve the high conflict divorce or custody battle? :
  • How prepared are you to make this commitment of time, energy and money to yourself? (1-10, 10 high) *:
  • What do you feel is your life’s purpose? *:
  • Is there anything else you want us to know about you? :
  • Mobile Phone :
  • Company Name :
  • Company Phone :
  • Website :
  • Home Phone :
  • Address *:
  • City *:
  • Country :
  • Zip / Postal *:
  • State / Province *: