| Coach
Judi Stifel, Life & Relationship Coach Personal-Self Quest & Relationship Negotiations Workshop Registration Form |
||
| After you have scheduled your appointment or reservation, please print, complete this registration form, sign, and bring with you with payment to the first meeting. Please note that this is an educational program only and I am acting as an educator and coach, and not a therapist and with no intention of practicing any kind of therapy or being liable from a therapy perspective. I am serving education and not therapy. Please practice Due Diligence as you would with any other form of education in which you participate. Judi Stifel | ||
| Name:___________________________________________ | E-mail Address: ________________________________ | |
| Address: (optional)________________________________________________________________________________ | ||
| City:__________________________ | State:__________ | Zipcode:___________________ |
| Phone: _____________________ | Phone: _______________________________ | |
| Marital Status:________________ | Age Range:_______________________ | |
| Have you brought someone with you?________ What relationship are they with you?________________________ | ||
| If you have brought a minor, what is their age? ___________________ What is their gender? ______________ | ||
| What issue is your chief concern?____________________________________________________________________ | ||
| What is your chief obstacle?_________________________________________________________________________ | ||
| What is your main goal? ____________________________________________________________________________ | ||
| What is your short-term goal?_______________________________________________________________________ | ||
| What is your long-term goal?________________________________________________________________________ | ||
| What other steps have you taken
to reach your goals?___________________________________________________
________________________________________________________________________________________________ ________________________________________________________________________________________________ |
||
| If you have brought someone with
you, what are their issues or your issues with them? ________________________________________________________________________________________________ |
||
| How did you learn about my workshops?______________________________________________________________ | ||
| Is there something special you
would like me to address for you?__________________________________________
________________________________________________________________________________________________ |
||
| Do you understand that you need
to attend all sessions, and in the correct order presented to gain the full benefit from the program as each session is foundational for the next? ______________________________________ |
||
| Do you understand that this
program is educational and does not constitute therapy for you or your companion?________________________________________________________________________________ |
||
| If you are attending with your minor child/children, do you give permission for them to attend?____________________ | ||
| I am an Educator and Coach. My
products and services are educational/coaching programs and materials.
"Therapists" work from a disease model. "Coaches" work from a healthy person model and we educate and support. My purpose in presenting information is to educate and coach as best I can with the hope that this education and coaching will enrich the lives of others and help them reach their various goals, whatever they may be. I have no way to guaranty the effectiveness of any program for a specific person, and I am in no position to control or be liable for how this education is used by the recipients, nor can I guaranty that it will be in any way useful. As with all education, Knowledge is Power, but not until it is used responsibly and effectively by the recipient. Judi Stifel, Life & Relationship Coach Appointment for In-Person or Telephone Counseling - Email: judi@coachjudi.com
|
||
| Print
Name:__________________________________
|
|
| Sign Name:__________________________________ | Date___________________________ |
© Judith L. Stifel 1996–2012. All Rights are Reserved