Enrolment Form

Individual Consultations $40hr

Min 2 hrs - One on One/ face to face- Sunshine Coast QLD
*It is recommended that 2hr seesions happen once a week for a period of 3 months to gain the best self esteem buidling results.

Childs First Name Surname

Childs D.O.B..
Childs School Year Level..

Parents First Names..Surname

Address.
State..Postcode.
Telephone Home
Childs Mobile (if applicable)...
Parents mobile..

Email.
Once enrolment form is received and confirmed, an invoice shall be email with payment details
Please either print and post form to: Self Esteem Co. U706 Points North Apartments 38-44 Queen
St Kings Beach QLD 4551 or Scan and email to selfesteemco@iinet.net.au

Prelimenary Questions.
What has prompted you to enrol your daughter into some individual consultations?

What results are you wanting for her from working with Janis Garner/Self Esteem Co.?

Is your daughter in agreeance with attending 2 hrs worth of consults?

What is your main self esteem concern for your daughter?

.
Please use this space to to add any additional information you would like Janis (Coach) to know.