Six-Week Self-Leadership Coaching: Child Needs Assessment. Coaching & Development - Registration FormThe goal goes beyond better grades. We want each child to develop the confidence to say: “I know what I need to do. I can direct myself to do it. And I can take responsibility for what happens next.” Please complete this form with accurate information about your child. The information provided will help us understand your child’s needs and goals and prepare appropriately for the six-week coaching experience.SECTION 1 - About Your ChildHelp us understand your child's current development goals and challenges.First NameLast NameAgeGenderSECTION 2 — Parent/Guardian InformationSome description about this sectionFirst NameLast NameRelationship to childPhone NumberEmailSECTION 3 — Understanding Your ChildWhat would you most like your child to improve through this programme?What are your child's current goals?Which areas would you most like your child to develop? Setting meaningful goals Building effective systems and routines Managing distractions Taking action without always needing motivation Building consistency Taking responsibility Thinking and solving problems Becoming more independentWhat does your child find most challenging when trying to follow through on goals? Getting started Staying focused Managing distractions Staying consistent Taking responsibility Managing routines Solving problems Lack of motivationPlease tell us anything else you think the coach should know about your child.SECTION 4 Please answer the following questions honestly to help us understand your child's daily patterns.PART A — Self-Leadership DevelopmentLinear scale: 0–5 0 being the lowest 5 being the highestThink about the last three things your child started this month: homework, a chore, a personal project. How many did they finish without being reminded? 0 1 2 3 4 5When your child sits down to study or do homework, how long does it usually take before something pulls their attention away? Linear scale: 1–5Describe the last time your child didn’t do something they were supposed to do. What happened, step by step, and how did they respond when it wasn’t done?Part B- Initiative, Ownership, and Instant GratificationInitiative (studies): On a typical day, does your child start their homework or revision on their own, or do they usually need to be reminded or prompted? Describe what usually happens.Ownership: When your child doesn’t do well on a test, assignment, or task, how do they usually explain it, in their own words, if possible?Instant Gratification: If your child has to choose between something fun right now (games, TV, phone) and something that helps them reach a longer-term goal, what do they usually choose? Describe a recent example (if any).SECTION 5 — Your Child's Perspective Growth is a family journey. Please fill with your wardWhat is one thing you would really like to improve about yourself?What is one goal you would like to achieve in the next six weeks?What usually stops you from achieving your goals? I get distracted I lose motivation I forget I don't know where to start I find it difficult to stay consistent I need someone to remind me I give up when something becomes difficultCoaching Method- Select -1 on 1 CoachingGroup CoachingConfirmations & AgreementsPlease review and confirm the following program agreements. I confirm that I am the legal parent/guardian of the child registered and have the authority to sign them up for this coaching program. I understand that active participation and consistency are key to the success of this coaching programme. I understand that outcomes depend on individual effort, follow-through, and home support, and that results may vary. I consent to the collection and secure storage of my family's intake data for the purpose of personalizing the coaching experience.Submit Form
