Life Coaching & Support Groups Registration

Harambee House of Wellness

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"There is no greater agony than bearing an untold story inside you."-Maya Angelou

Do I Need Life Coaching?

* I feel like there is more to life
* I feel stuck in a rut
* I don't know who I am anymore
* I need a change
* My relationships need work
* I need help with my health
* I keep repeating the same behaviors over and over
* I need more spiritually
* I want to lose weight and keep it off
* I'm going through the motions but not feeling fulfilled
* I know what I should do but can't seem to follow through
* I feel disconnected from my purpose or passion
* I'm overwhelmed by all the changes I want to make
* I sabotage myself when things start going well
* I'm ready to invest in myself but don't know where to start
* I feel like I'm living someone else's life, not my own
* I have big dreams but lack the confidence or plan to pursue them

Life Coach Registration Form

* Indicates required field

Name *

First

Last

Phone Number *

Preferred Name *

D.O.B *

MM/DD/YYYY

Address *

Line 1

Line 2

City

State

Zip Code

Country

Which program are you signing up for? *

Community Group Life Coaching Y.E. First Life Coaching (Individual) Y.E. First Life Coaching (Couple) Y.E. First Life Coaching (My Own Group) Dual Harmony Project Awaken The Sun Psychic & Spiritual Development Wealthy Womb Sacred Vitality Bring Sacred Vitality Workshop to you Chakra Enlightenment Sensual Poetic Alchemy The Sound Bowl Sanctuary

Email *

Emergency Contact Name *

First

Last

Emergency Contact Phone *

Relationship to Emergency Contact *

Which Form of Payment? *

Bringing Cash (Before Classes Begin) Zelle (Preferred) 678-933-1386 CashApp Venmo Debit/Credit Other

Fill out Form *

Max file size: 20MB

Complete this at least 1 week before first session.

Community Group Sessions continue here:

Will you be participating in our specials? *

I will bring a friend The Early Bird Special Both Neither Not attending Community Coaching

Which payment schedule will you be choosing? *

Weekly Monthly Quarterly Other Not attending Community Coaching

Any Questions? *

Submit

"Where spirit meets community."

Home
About
Rates & Services NEW!
- Upcoming Events
Contact
- Testimonials