Beta Parenting Bundle -Impact Parenting
Ready to apply? It’s easy! Simply fill out this form and I’ll be in touch.
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Name:
Email:
Comment:
Email Address
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First Name
Last Name
What country do you currently live in?
What is your timezone?
Other please state...
Other please state....
How old is your child/ren?
0-3
4-7
8-10
11-16
17-18
Age of multiple children
Which of the following describes your parenting?
Permissive - no rule parenting
Authoritative - strict and warm
Conscious - Observe and own self, not child
NOT SURE
Other please state....
Select best description of how you were parented..
Permissive - no rule parenting
Authoritative - strict and warm
Conscious - Observe and own self, not child
NOT SURE
Other please state....
Have you read my book on Disciplining With Love
Yes
No
Other
What are yours and your spouse's biggest struggle
What appealed to you about this parenting program?
What's the no.1 thing you want to learn about?
Can you spend 45 mins/wk to learn and implement?
Yes
No
and implementing what you have learnt?
Do you agree to attend a 30 mins feedback session?
Yes
No
Would like to provide a video testimonial?
Yes
No
Were you emotionally ready for quarantine?
Yes
No
Other please state....
Were you physically ready for quarantine?
Yes
No
Other please state....
Child's Name
