Optima Mindset Coaching: Foundations

Section 1 — Participant Info

First name*

Last name*

Birthday*

Month

Day

Year

School*

GPA*

Extra Curricular Activities*

City*

State*

Email*

Phone

Section 2 — Parent/Guardian Info

First Name*

Last Name*

Email*

Phone*

Section 3— Participant Questions

1. Why do you want to be part of the Mindset — Foundations Program?*

2. Where does pressure show up most for you?*

3. When pressure or doubt show up, what does that feel like in the moment?*

4. What do you want to get out of these three weeks?*

5. Are you able to attend all three scheduled sessions.*

Yes

No

Not sure

6. Are you prepared to participate, reflect, and show up consistently?*

Yes

No

Not sure

7. Anything else you’d like me to know?

SECTION 5 — Consent (Parent/Guardian Completes)

I acknowledge this is mindset coaching, not therapy or counseling.

I give permission for my teen to participate in this program.*

Drawing mode selected. Drawing requires a mouse or touchpad. For keyboard accessibility, select Type or Upload.

bottom of page