Intake Form - COACHIINTAKE FORM - The Intuitive & Soulful Impact Live Coaching Experience Please take your time filling out the questions below. They are intended to support you in getting clear on what you want to accomplish in this Experience and to let us see if what you want to accomplish is a match for the program. If it is not, we will let you know and will refund your tuition. So, please be as authentic as possible so we can be sure this program is a match for what you want and need. Thank you. > Kay & The Peak Awakening TeamFirst NameLast NameEmailPhone/MobileAddressAddress Line 1Address Line 2CityStateZip CodeCountrySelect CountryAfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelauBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicDemocratic Republic of the Congo (Kinshasa)DenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRepublic of the Congo (Brazzaville)ReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (Dutch part)Saint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom (UK)United States (US)United States (US) Minor Outlying IslandsUnited States (US) Virgin IslandsUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaYemenZambiaZimbabweBirth DayFULFILLMENT QUESTIONSThe following questions are specifically worded to evoke curiosity, wonder and intention with regards to your participation in The Intuitive & Soulful Impact Live Coaching Experience. Please write down the answer that first comes to mind, no holds barred. Do not judge what you write; instead, let it flow through you. You might actually be surprised by what you say! This Experience will result in the fulfillment of what you write below.What aspect of one of your Soul Dreams do you see you would want to bring to life by participating in The Intuitive & Soulful Impact Live Coaching Experience? If you could manifest this aspect of your Soul Dream, what would that mean to you? On a scale of 1-10, how ready are you to do the work over the next 5 months to have this Soul Dream be yours?Why didn’t you pick a lower number?Imagine you have manifested this aspect of your Soul Dream, you are living in alignment with your soul, what would the positive outcomes be? Why are those outcomes important to you?What other soul-aligned results or breakthroughs would make this Experience wildly successful for you? What do you want to feel more of in your life by the end of this program? GETTING TO KNOW YOU QUESTIONSWhat are you currently doing to support your mental, emotional, or spiritual well-being?What’s calling you to do The Intuitive & Soulful Impact Live Coaching Experience right now?When you’re facing a challenge, how do you typically respond or move through it? This Experience is fast-paced, growth-focused, and soul-aligned. What makes you feel ready for that right now?How do you see you will sabotage your success in this Experience? What will predictably take you out?What are you most proud of accomplishing in your life or career so far?Is there anything else you’d like to share to help me support you during this Experience?How’d you find out about us? If it was someone who told you, what’s their name so I can say thank you!ATTENDANCE QUESTIONSPlease record your attendance as best as you know it right now. If your attendance changes, please email Kay and copy Jessa. You will be reminded of this in the first session. (NOTE: If you are doing the extra 30 minute pre-certification training at the end of each session, please do not indicate that on this form. We will deal with that at a later date).1. MISSING CLASS: Please check the box of the date of any session you know you will be missing. Thursday August 14 Thursday August 21 Thursday September 4 Thursday September 18 Thursday October 2 Thursday October 16 Thursday November 6 Thursday November 20 Thursday December 4 Thursday December 18 I will be attending all classes (and if anything changes, I'll let you know)2. LATE FOR CLASS: Please check the box of the date of any session you know you will be late. Thursday August 14 Thursday August 21 Thursday September 4 Thursday September 18 Thursday October 2 Thursday October 16 Thursday November 6 Thursday November 20 Thursday December 4 Thursday December 18 I will be on time for all classes (and if anything changes, I'll let you know)3. LEAVING EARLY FROM CLASS: Please check the box of the date of any session you know you will be leaving early. Thursday August 14 Thursday August 21 Thursday September 4 Thursday September 18 Thursday October 2 Thursday October 16 Thursday November 6 Thursday November 20 Thursday December 4 Thursday December 18 I won't be leaving late for any classes (and if anything changes, I'll let you know)LIABILITY WAIVER & CONFIDENTIALITY AGREEMENT FORMSAfter you submit this form, you will be redirected to a page where you can sign a Liability Waiver and Confidentiality Agreement. If you are not automatically redirected, please refer to your onboarding email or the Peak Awakening Learning Portal for the link to the Liability Waiver and Confidentiality Agreement. IMPORTANT: You are not considered registered into the program until these forms are signed. Thank you.Submit Form