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Registration Form
This is the official registration form to join our amazing parenting community Parent Rising! I am so excited to welcome you into this group where we will have support and learn how to build connected relationships with our kids regardless of circumstances.
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If a friend referred you, would you list their name below? (special perks for referring friends!)
Your answer
Name:
Your answer
Email Address:
Your answer
Ages of your kids:
Your answer
What do you hope to gain from this group?
Your answer
Current pain points in your parenting
Your answer
Are you aware you will be charged $25 a month if you use Tier one pricing to be a part of this group? If you use Tier 2 it is $75 a month. Payment will be via my business Venmo account and must be paid by the 5th each month.
Yes
No
Clear selection
Which tier will you choose?
Tier 1 $25 (access to Facebook group, zoom calls, weekly Q&A's, group coaching, support)
Tier 2 $75 (access to all tier 1 has plus a monthly 1:1 coaching session with me)
Clear selection
Are you willing to be an active participant in our private Facebook group and be a supportive and compassionate community member while keeping what we talk about private?
yes
No
Clear selection
What is your current favorite song? (this has nothing to do with the group, I just want to get to know you better!)
Your answer
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