Parenting Coach Intake Packet

Name of Parent Coaching Business

Shifting parent perspectives through greater awareness of energy to experience more love, joy, and peace with your children - NOW

Phone: ???.???.???

1909 Anywhere Avenue

Anywhere, State, Mailing Code

E-mail: ______

Web Site:

Logo - Serving, Helping, Coaching, Educating, Transforming (Who and What)

Mary Everywoman, ACPI Certified Coach for Parents

Dear

Welcome to my coaching practice!

Personal letter to client goes here.

A parent coach is a trained and certified professional who could

•Help you achieve your goals,

•Empowers your change or transformation,

•Educates you in communication, temperaments, emotional skills, discipline, creating a fulfilling family life, solving problems, providing structures like sleep schedules, adapting to new situations, solving problems…

You see how parenting coaches are trained to help you move through parenting with ease and confidence.

As your coach, I will help you clarify what you want to accomplish, set specific goals and make an effective action plan. I integrate a variety of approaches in the work I do with clients. Although a particular method may seem different to you at first, I encourage you to ‘stretch’ with openness in order to realize your potential. I provide you with support, structure, perspective and techniques in the coaching process. I have been the parent of ______and can mentor you through the unique rewards and challenges of raising children.

Parent coaching is inspirational, educational and practical.

We will discover together how much you already know about how to create a healthy home life. In the occasional “need to know” moment, I will provide skills training in a practical way, so you can use new concepts and skills right away. Coaching is designed to unlock and maximize your parenting potential.

Parent coaching is transformational and beneficial.

The focus of coaching is achieving your goals in parenting and communicating with family members.

•We will identify specific plans and ways of thinking that will move you towards achieving your desired goals.

•True and lasting change happens in powerful moments of emotional inspiration and a willingness to explore beyond fears. I

•n our coaching relationship I strive to cultivate a safe and supportive space for the client to work toward personal growth, discovery and transformation.

•I may ask you to step outside of your comfort zone, challenge your perspective, or request you to become more attuned to your “inner voice”.

The structure of coaching is flexible. We will design a coaching arrangement that meets your individual needs and schedule. We can meet in person, by phone or via Skype depending on what’s most convenient for you. The basic steps are

•An intake interview

•An initial session to create a coaching strategy

•Regular on-going coaching sessions (in person or by phone), or

•Your participation in an educational course, group coaching, skills training.

Coaching sessions may be focused on one specific challenge you are facing, or on a much broader set of issues. Coaching relationships start with a 3-6 week commitment. The nature of the goals and the changes you wish to make will determine the length of time that makes sense for you.

1. The structure of parent coaching is flexible to suit the client’s individual needs and schedule. Our 30-minute collaborative interview has provided each of us with the information needed to determine whether our coaching alliance will become a good match.

2. The next phase is reviewing and completing this Parent/Coach Intake Packet. The Packet will assist me to know you better, let you understand specific coaching parameters, and may provide us with additional direction.

3. Upon returning the Packet, we can proceed to schedule our Initial Coaching Session. You can expect this session to last one to one and a half hours. This first session will set the tone and energy of our coaching relationship, narrow the focus, provide insight into your personal traits and temperament, and define your goals.

(Optional for coach to include) I request that all new clients make a minimum commitment of six weeks to three months to their own Life Process. “Life is a journey, not a destination.” Issues are rarely mended in a day, and it would be unrealistic to assume so.

Please Tell Me About Yourself

  1. What is your most urgent reason for coming to coaching?
  1. What area of parenting gives you the most satisfaction?
  1. In which area of parenting do you feel the most challenged, frustrated or annoyed?
  1. How do you view the level of balance within your family?
  1. If you share parenting responsibilities, please describe the dynamic between you and your spouse/partner when it comes to parenting.
  1. How would you describe your parenting philosophy?
  1. What are the major stressors in your life?
  1. What would be your vision of a good outcome for your family?
  1. What coaching approaches do you think will encourage and motivate you? What approaches may discourage and de-motivate you?

Parenting Descriptors

Please circle the ten parenting descriptors that are most important to you and rate them “1” to “10” with “1” being the most important.

Harmony / Role Model / Control
Nurturing / Responsibility / Tough Love
Support / Integrity / Wealth
Affection / Fairness / Spirituality
Safety Net / Organization / Faith
Self Sacrifice / Instruction / Religion
Mutual Respect / Enrichments / Community Service
Patience / Creativity / Arts
Individualization / Spontaneity / Literature
Flexibility / Variety / Nature
Dedication / Enthusiasm / Fitness
Advocate / Fun / Social Justice
Protective / Enjoyment / Culture
Problem Solver / Independence / Travel
Family Time / Autonomy / Sports
Family Unity / High Achievement / Humor
Communications / Discipline / Other:

Required Coaching Agreement

The document and attachments constitutes a contract (the “AGREEMENT”) between us. I ask that you read it carefully and raise any questions and concerns before you sign it.

Coach/Client Relationship

I commit to our coach/client relationship becoming a place where understanding, mutual trust, emotional safety and support are the norm. The relationship between the coach and client is specifically designed to be client-centered. The client sets the agenda and the success of the enterprise depends on the client’s willingness to take risks and try new approaches. The relationship is designed to be more direct and challenging. You can count on me as your coach to be honest and straightforward, asking powerful questions and using challenging techniques to move you forward. It is also important to understand that coaching is a professional relationship. While it may often feel like a close personal relationship, it is not one that can extend beyond professional boundaries both during and after our work together. Considerable experience shows that when boundaries blur, the hard won benefits gained from the coaching relationship are endangered.

As your coach I am firmly committed to your success in your parenting journey, and I ask the same of you. Therefore, please read and fill in your name as well as read each question and circle your response.

  1. I, ______am committed to creating a successful alliance with Mary Everywoman, ACPI CCP, who supports my family and me in reaching my parenting goals and creating the family life I desire. YES NO
  2. I agree to take responsibility for my own choices, decisions and actions throughout our coaching relationship, as well as for my inconsistencies or inactions. YES NO
  3. I agree to allow my coach to hold me accountable when I am distracted from my goals. YES NO
  4. I agree to give my coach permission to challenge me for my inconsistencies and inactions. YES NO
  5. I give my coach permission to challenge me with powerful questions and inquiries to keep me focused and open to new possibilities. YES NO

6.I agree to be honest and straightforward with my coach and myself concerning those issues blocking me from moving forward to create a fulfilling family life. YES NO

7.I agree to work with my coach to clarify what I want to accomplish, and set goals and put action plans into practice. YES NO

8.I agree to approach my coaching sessions mentally and emotionally prepared. YES NO

9.I agree to take part in my coaching session in a distraction free and quiet place for the duration of the session. YES NO

10.I agree that I will not engage in a phone session while I am driving, at work, or otherwise similarly occupied. YES NO

11.I agree that responsibility and accountability for my mental, emotional, and physical health, including my choices, goals and decisions, as well as my evaluation of such, are solely mine and not that of my coach. YES NO

12.I agree to be honest with my coach and myself in evaluating and reporting my progress or difficulties between coaching sessions, and that I will accurately report my personal efforts to my coach. YES NO

13.When our coaching alliance and strategy is not working as I wish, I will immediately inform my coach, so we can take mutual steps to correct the problems. YES NO

Coaching vs. Therapy

While there are some similarities between coaching and therapy, they are very different activities. Psychotherapy is a health care service and is usually reimbursable through health insurance policies. This is not true for coaching. Both coaching and psychotherapy utilize knowledge of human behavior, motivational and behavioral change, and interactive techniques.

Parent coaching is a strong, supportive, and collaborative partnership between coach and client, in order to advance the client’s personal goals and facilitate connection within the family. While parent coaching is not therapy, it is often therapeutic. The outcome of parent coaching is often the healing of old history.

(Optional) Please note, however, that coaching services donot or cannot take the place of qualified mental health services when they are needed. Therefore:

14.I agree to tell my coach if I am working with a therapist or other professional, as this information will assist my coach in understanding my current situation. YES NO

15. If I am currently in therapy, counseling, or under the care of any mental health professional, have I informed this person of my decision to participate in a coaching relationship as defined in this agreement? YES NO

16. If my coach suggests I seek the services of a mental health professional for my own health and wellbeing, I agree to take this suggestion under serious consideration. YES NO

17. I will continue seeing my regular therapist and taking all current medications as prescribed during my coaching relationship. YES NO

Coaching Services and Fees

The services to be provided by Mary Everywoman, ACPI Certified Coach for Parents are:

•Coaching in person,

•Phone-coaching,

•Using email exchange or other on-line private exchange vehicle as designed jointly with the client.

•Crisis call

Therefore:

18.I agree to schedule my Initial Coaching Session at the rate of ______. YES NO

(This fee includes a 90 min. session, assessments and review, focused goals and formation of an action plan)The fee for this session is non-refundable.

19.Not including the Initial Coaching Session, I agree to invest in my parenting journey through coaching for the agreed minimum time of six weeks in this package..

This New Perspectives Package consists of 6 hours of coaching which can be broken down into increments of 30- or 60-minute sessions. Total fees for this Package are $575.00 and include ‘spot coaching’ in the form of emails relevant to main point from sessions or occasional brief phone calls kept under 15 minutes. All fees for this Package must be paid by the first of the month prior to those months first session at the rate of $287.50 per month, which will constitute equal payments. (unless an alternate arrangement is agreed upon in writing).

YES NO

20.Not including the Initial Coaching Session, I agree to invest in my parenting journey through coaching for the agreed minimum time of three months.

  1. This Discovery Package consists of 12 hours of coaching which can be broken down into increments of 30- or 60-minute sessions. Total fees for this Package are $900.00 and include ‘spot coaching’ in the form of emails relevant to main point from sessions or occasional brief phone calls kept under 15 minutes. All fees for this Package must be paid by the first of the month prior to those months first session at the rate of $300.00 per month, which will constitute equal payments. (unless an alternate arrangement is agreed upon in writing).

YES NO

21. I have been informed that upon the completion of the above Package I may purchase another Package or continue (if I choose) with additional single sessions at a rate of $125.00 per hour, and $60.00 per thirty minute session. YES NO

22.I have been informed and I agree that all fees for coaching sessions must be paid in advance, and cleared in my coach’s account prior to the session. Currently payment may be made by cash, check or money order, made to: Energetic Parenting. Services not paid for in advance will not be provided, and may be delayed until payment is received. YES NO

23.If I am late for a session, my session will be shortened by the number of minutes I am late. The fee for that session will remain the same. YES NO

24.I agree to cancel and/or reschedule any appointments 24 hours or more in advance, or forfeit that appointment and pay the fee. YES NO

25. I have been informed that my coaching relationship with ______(coach) may be terminated by me or ______with advance notice. YES NO

26.I agree that I will pay any outstanding coaching fees at the time of termination of the coaching relationship. If I have money on account in excess of that which is necessary to pay for services rendered, my coach will make a full refund of those excess funds with a written request. I have been advised that the sole reason for the written request is for bookkeeping purposes.

YES NO

Confidentiality

27. I have been informed that any information provided to my coach by me or others (i.e. a therapist) will be kept strictly confidential. All information whether electronic or in other formats may only be shared with my consent. YES NO

28. It is impossible to protect the confidentiality of information that is transmitted electronically. This is particularly true of e-mail and information stored on computers that are connected to the internet, which do not utilize encryption and other forms of security protection. YES NO

29.I have been advised that if I make statements that cause my coach to think I may harm others or myself, my coach is required to contact my local law enforcement agency and report these statements to local officials. YES NO

I congratulate you on your decision to grow and strengthen yourself and your family life. I am enthusiastically looking forward to working with you on your journey.

______(Signature of Client)

______(Date)

______(Signature of Coach)

______(Date)

Intake Packet for Parents 1