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Parent Details
Parent Name:
Contact Email:
Contact Phone Number:
Student Details
Name:
Gender:
-
Female
Male
Age:
Name of School/Kindergarten/University:
Year Level:
-
Kindergarten
Foundation/Prep
Year 1
Year 2
Year 3
Year 4
Year 5
Year 6
Year 7
Year 8
Year 9
Year 10
Year 11
Year 12
VCAL
Tertiary
Academic challenges student is facing:
Mathematics
Writing
Reading
Spelling
Other (please specify)
Other:
Personal challenges student is facing:
Behaviour
Relationships/Social Skills
Communication
Confidence
Self-regulation
Trauma
Anxiety
Organisation
Memory
Motivation
Other (please specify)
Other:
Student has the following known/possible diagnosis:
Please tell us what you would like to achieve from Learning and Life Coaching:
Is there any other information that will assist us in working with your child?
Best times for Learning and Life Coaching session (please select a minimum of 3 preferred sessions):
Saturday (9:00am to 1:00pm)
Saturday (1:00pm to 4:00pm)
Monday (3:45 – 6:00pm)
Tuesday (3:45 – 6:00pm)
Wednesday (3:45 – 6:00pm)
Thursday (3:45 – 6:00pm)
Friday (3:45 – 6:00pm)
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Educators & Schools
F2F Workshops
Webinars
Online Courses
Human Literacy™
On-Site Learning
Consultancy
PLC Learning
Professional Coaching
Student Workshops
Young People & Families
Family Consultancy
Group Workshops
About Us
Why Us
Our Story
Our Team
In the Spotlight
Blog
Contact Us
Request Us