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Parent/guardian/client Coaching Agreement Form - A T T E N T I O N S O L U T I O N S

A t t e n t i o n S o l u t i o n s

A D H D L i f e C o a c h i n g

Parent/Guardian/Client Coaching Agreement

Student/Child/Person Being Coached: ____________________________________________

Date of Birth: _________ Age: ________ School: _____________________ Grade: _______

Address: ______________________________________________________________________

City: __________________________________ State: _______________ Zip: ______________

Home Phone: _______________________________ Cell Phone: _________________________

Do you have unlimited texting? Yes No

Email Address: ________________________________________________________________

Is this your email or your parents? ____ My Email ____ My Parent’s Email

School: _________________________________________________ Grade/Year: ___________

Job: ___________________________________________________ Hours/Week: ___________

Preferred Phone: _______________________________________________________________

Client Contact/3

Party Information

Mother’s Name: _______________________ Father’s Name: __________________________

Other Guardian Name: __________________________________ Relationship: _____________

Address: _____________________________________________________________________

City: __________________________________ State: _______________ Zip: ______________

Mother’s Preferred Phone: _______________

Father’s Preferred Phone: ________________

Guardian Preferred Phone: _______________________________________________________

Residence or Secondary Phone: ___________________________________________________

Parent Email Address(s): ________________________________________________________

Parent/guardian/client Coaching Agreement Form - A T T E N T I O N S O L U T I O N S