Group Parent Coaching Program Application
First Name
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Last Name
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Co-Parent's Name
Email
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Phone
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How many children do you have?
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What are the ages of your children? (Please list from youngest to oldest)
YOUR PARENTING: Which of the following areas do you feel need improvement, need to be addressed or are areas of concern in your life?
Lack or need support with my parenting skills
Difficulty with managing my frustration or anger in challenging situations with my child
Difficulty helping my child when they are sad or withdrawn
Difficulty with my own past and how I was parented; it's possibly affecting my parenting today
Difficulty communicating with my child
Difficulty connecting with my child on an emotional and/or intellectual level
I feel lack of confidence as an individual and it affects my parenting
I feel lost and confused sometimes doing this parenting thing
I would like more support in my parenting journey with my child
I don't know how to get my child to listen and do what I ask them to do
I am a perfectionist and I think this is impacting my kids
I have a strong personality and like to have control
I'd like to learn more about child development and brain development so I can support my kids better
I have anxiety or anxious overwhelm and not sure how to manage my own healing and growth along with becoming a Conscious Parent
I have unresolved trauma that impacts my parenting and family life (P.S. All of us have trauma in some shape or form)
I have suspected or diagnosed ADHD and this impacts my parenting
Toxicity: Are you currently navigating, or have you in the past navigated, toxic or harmful relationships? (Including your own parents...)
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Yes
No
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Can you provide 3 factors you feel are negatively influencing the situation as it stands right now?
What are 3 major outcomes you want to experience from group parent coaching?
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How will your family life be different when those outcomes are achieved? What will it look like? How will it feel?
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What is the primary concern you have for your parenting? This would be the one thing that if it could shift, would make a dramatic improvement in your parenting life?
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Progress 'til date: what have you done to address your concerns so far? Have you attempted self-esteem or self-confidence coaching before for yourself or your child, or engaged in any parent coaching? Have you or your child engaged in therapy (psychologist, counselor, or psychiatrist)? If yes, please describe your experiences below:
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Is there something else that needs to be addressed not mentioned above? If yes, please describe.
BEFORE YOU CONTINUE: PLEASE READ CAREFULLY AND SELECT YES, TO INDICATE YOU UNDERSTAND AND AGREE. COACHING IS NOT A REPLACEMENT FOR THERAPY, therapeautic psychological treamts or diagnoses, or therapeutic counseling; if you are strictly seeking therapy but for any reason cannot do so, coaching is not a suitable replacement. It is important to note that many people pursue coaching while also receiving psychological support for more serious concerns. The Confidence Coach’s Kids and Parent Coaching programs are meant to be proactive and restorative. Self-Esteem and Self-Confidence Coaching has it’s foundation in educating clients, applying neuroscience principles, and providing a mirror to clients to help them understand their own inner potential and inner power which is difficult to do on our own; this can include but is not limited to understanding limiting beliefs and reframing negative thoughts or self-concepts. Coaching is known for giving clients many “aha” moments that change their lives. The Confidence Coach is a trauma-educated professional but does not treat trauma. Although The Confidence Coach has worked with many kids who have anxiety, severe or debilitating anxiety is not something that fits in the realm of coaching. Coaching is meant to be a clear communication vessel. Coaches advocate that clients know themselves best and thus communication is the key in successful client-coach-child relationships.
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Yes
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PARENT COMMITMENTS - Are you able to commit the time, energy and effort to help your family and enhance your parent life and, do the work needed to achieve those outcomes? Coaching is a two-way portal toward creating the outcomes you want. This means you as a parent need to be willing and ready to do the work necessary to make it happen. It is possible that once you have started coaching with me, you will have 'Empowerment Work' to do each week which can require a 1-1.5 (+/-) hour commitment bi-weekly. Are you willing to do what it takes? IN ALL CASES, my promise is to work with your family to help you attain the outcomes you desire. I understand that parenting can be hectic and exhausting, therefore, if you are unable to commit additional time to the work in addition to the coaching session itself with me, then sessions will be adapted to cover information from any course materials, books or workbooks, in the coaching session itself. This does mean that you may require more sessions to achieve your goals. Many clients choose to focus their energy on the sessions themselves, and I want you to know that it's okay.
Yes, I understand and commit. I will advise the coach of any of my challenges in doing the work required.
No, I don't like this. I don't want to do this extra work.
I don't want to do any course materials, workbooks, etc. I just want the coach's time/energy in the coaching session itself.
Are you in the financial position to invest in your parenting and family life in order to achieve the outcomes you desire?
Yes.
No.
About the Sessions: Sessions are 60-75 minutes long allowing space for the up to 6 (max) sets of parents to share and ask questions, while also covering a crucial topic/learning point with the coach. Statistically, many parents who start with group coaching request one-on-one support as well due to the nature of their concerns. Group coaching, although starting with 12 sessions, can be continued indefinitely so long as groups are available with vacant spots for parents. Many families continue coaching for up to two years with me because they are seeing a lot of value in it. Please indicate that you understand.
Yes, I understand.
No, I don't understand.
I think I get it, but need more info.
How did you hear about 'The Confidence Coach' / Ashley Anjlien Kumar? E.g. Facebook Group, Google Search, Referral from a friend, Other - please describe.
Next Steps: When you click "submit" you will be taken to the payment platform to complete your registration. Please indicate you understand.
Yes, take me to the payment page.
No, I changed my mind.
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