Life Aligned Academy

New Client

Application Form

Welcome! We are so excited to know if you are ready for the Life Aligned journey!

Please complete the application so we can consider you for this program. The more details you give, the better.

Answer with what’s true for you – there are no right or wrong answers!

Which Coaching Program are you Applying for
Please provide your first name.
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Please provide your surname/last name.
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Please select your date of birth.
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Country of Residence
Please Select the country you live in.
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Please provide your contact number.
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Please provide an emergency contact name and number.
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How did you hear about this program?
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Have you had or been diagnosed with any mental or medical disorders? If yes, please provide some details.
What concerns or hesitations, if any, do you have about participating in this program?

Life Alignment Coaching

Please name at least 3.
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Can you describe them in detail?
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How will your life change when you achieve them?
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Couples Alignment Coaching

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Birthing Source

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1
I'm not ready at all. YES! I'm willing and committed!
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I would love to be considered for the selected program. I understand that by submitting I am showing my interest in the course, and I am under no obligation to make payment or join. If I am accepted, I commit to doing what I need to do to get 100% out of this experience, and will support others in the community to achieve their goals too. *
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