Parenting Mojo

Client Coach Agreement

Please print, sign, date, and bring this to your first appointment at
2233 University Ave West, #325, St. Paul, MN or email it to tina@parentingmojo.com.

What you can expect from your coach:

  1. Maintain confidentiality at all times regarding your parent- or teacher-child relationship.
  2. Provide an initial 1.5 hour intake and 60-minute parent coaching sessions on a regularly scheduled basis, beginning with four total sessions, and as needed after that.
  3. Use knowledge and experience for the betterment of your parenting or teaching relationship at all times and hold your family or classroom as a highly valued, healthy entity.
  4. Charge fees that are reasonable with no hidden costs.
  5. Be open for brief troubleshooting phone calls between coaching appointments.
  6. No therapy, as coaches are generally not licensed therapists.  Rather,  we will coach you on the specifics of applying Present Moment Parenting in your home or classroom.  We will celebrate your successes with you!
  7. Refer you to a therapist if it is determined to be necessary.  Our parent coaching relationship may continue during the time that the therapy is taking place.  If coaching does continue, we acknowledge that it is training in a specific set of skills, and is complementary to the therapy.

What your coach will expect from you:

  1. You agree to meet in person at 2233 University Ave West, #325, St. Paul, MN, or connect with your  Parenting Mojo coach by phone, Google+ or Skype for each parent coaching appointment at the designated time.
  2. You agree to cancel or reschedule your appointment 24 hours in advance if your plans need to change. If this does not occur, it will be necessary to apply the customary charge.  Click here to reschedule.
  3. You agree to report three successes to your coach at the beginning of each session.  This is intended to keep you focused on success with the child.
  4. You agree to pay your fees at the time of service. Payment in advance, in four-session packages, is customary. Visa and MC accepted. Payment plans and sliding fee scales are available, but no refunds.

Thank you for your trust in our parent coaching services.  We look forward to working with you and bringing out the very best in the intense child/children in your life!

ParentingMojo Coach (electronic signature)

Client Signature __________________________________________   Date ____________

Print Name _______________________________________________________________

Client Signature __________________________________________  Date ____________

Print Name _______________________________________________________________

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Names and ages of children:

_____________________________________________________  Age:______________

_____________________________________________________  Age: ______________

_____________________________________________________  Age:______________

_____________________________________________________  Age: ______________

_____________________________________________________ Age:_______________

_____________________________________________________  Age: ______________

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Payment Type:

__Credit Card Number _____________________________________ Exp. Date_________

__Check  (payable to Center for the Challenging Child)

__Cash

 

Office Use Only:

Amount Paid: ___________  Date: ____________

Amount Paid: ___________  Date: ____________

Amount Paid: ___________  Date: ____________

Amount Paid: ___________  Date: ____________