Participant Intake Form

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+13025211794

coach@progressivefitnesscoaching.com

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Personal Information

Full Name:

Preferred Pronouns

Email:

Phone:

Emergency Contact Name:

Emergency Contact Phone:

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Workshop Goals

What motivated you to join The Human Growth Experience?

Seeking personal growth

Gaining clarity in life direction

Overcoming challenges or obstacles

Building confidence

Other

If other is selected, please specify:

What specific outcomes are you hoping to achieve during this workshop?

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Background and Preferences

Have you participated in any personal growth workshops or programs before? If yes, please specify:

Are there any specific areas of your life you’d like to focus on?

Career

Relationships

Self-confidence

Creativity

Emotional resilience

Other

If other is selected, please specify:

What learning style suits you best?

Visual (seeing/reading)

Kinesthetic (doing/experiencing)

Auditory (listening/speaking)

Combination

Unsure

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Health and Safety

Do you have any physical limitations or health conditions we should be aware of (e.g., allergies, mobility issues, chronic pain)? If yes, please specify:

Are there any emotional or mental health considerations you’d like us to know about to create a safe environment for you? If yes, please specify:

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Participation and Reflection

What does ‘creating your new story’ mean to you?

What challenges or barriers are you currently facing in life?

What strengths or qualities do you feel will support you in this experience?

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Additional Information

Do you have any questions or concerns about the workshop?

Is there anything else you’d like us to know about you?

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Acknowledgement

By submitting this form, I confirm that the information provided is accurate to the best of my knowledge. I understand that The Human Growth Experience is a personal growth workshop and not a substitute for medical or psychological treatment.

I agree

Thank you for contacting us.
We will get back to you as soon as possible.

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P.O. Box 1076, Hockessin, DE 19707

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