Spring 2026 Application, EF Coaching with Seth Perler
Program runs form January - May

Hi Parents,

This application helps us make sure the Momentum Executive Function Coaching Program is a good fit for your child.

If approved, I’ll send you the payment link within 72 hours.

It’s first come first served for the first 10 families.

We begin Sunday, January 11, 5pm PT, 8pm ET

In gratitude and service,
Seth Perler

🛑 Remember to CLICK SUBMIT at the end, or I will not get the form (Yes, this happens)
Sign in to Google to save your progress. Learn more
Email *
PARENT EMAIL What is your exact email address where you want me to send Momentum info, that you know will get to you? (you can add more than 1 parent emails here)
PROGRAM DETAILS: Did you read the details here on my site: https://sethperler.com/courses/momentum/ before doing this application, to make sure you know how Momentum works? 
DATES + TIMES: Are you sure the schedule works and your child will be able to show up? (It's ok if there's a legitimate reason to miss or be late to a session or two, but it should be minimal.)
 *
PARENT NAME(s): So I understand who I may be in contact with on zoom, calls, or emails, please include all parents, relatives, care givers who will be involved this semester, even if in different households. *
Child's Name *
Child's Age, Grade, and other basics you want me to know about, ex: if there is an ADHD diagnosis, etc? (I refer to notes from this form as I work with your child throughout the semester)
 *
Your Timezone + General Location? *
(Optional) Your phone number for WhatsApp coaching

 *
ABOUT YOUR CHILD: What are your child's interests, passions, hobbies, musical interests, sports, curiosities, strengths, gifts, talents, what matters to your child, etc? Just list a few key bullets so I can understand your child better... *
READINESS: This program is only for kids who want help, and who want to work with me. A little resistance is normal at first, but this is a great group of kids who get to know each other, and is a place for kids who want to be here. How ready is your child for MMNTM? Do they want help? Please explain briefly... *
Type of school? Help me understand the schooling situation: Homeschool, private, public, small, big, supportive, not supportive, etc? 
What do I need to know so I can better help your child?
 *
TOP 3 CHALLENGES: In your opinion, what are 3 of your child's biggest challenges that hold them back, that you hope I can help with? 
Be as detailed as you want.
 *
DIVERSITY: Note, this is an eclectic group of accepting students and parents. They are neurodivergent, quirky, and very diverse in every way. ALL kids are 100% welcome in my groups. Are you accepting of a very diverse group? *
ZOOM: Kids must be willing and able to be on camera for important parts of the sessions, like group checkins, or 1:1 breakout rooms with me. These are not recorded, but I cannot run a group with empty rectangles on a screen. 
This is about real humans connecting, so you need good internet and a device with working audio and video. (For example, school ChromeBooks often are limited, and it makes calls difficult)
Clear selection
WHY SETH? There are countless coaches out there, why do you want your child to work with me in particular? *
Anything else?
🔥 BE SURE TO CLICK SUBMIT, or I will not see this form.
Clear selection
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
PrivacyTerms
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms