First Name
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Last Name
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Email
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Phone
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How did you learn about Creating Champions For Life?
What is your level of understanding of how we help families?
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Just Learning
I've Watched a Few Videos
I've Been Following for a While
I Love What You Do, Need Help Implementing
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How many children do you have?
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What are their age groups?
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0-2
3-5
6-9
10-13
14-18
More than 18 y.o
Are you raising your children alone, or do you have support?
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I am alone
I have support
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Supports:
Spouse
Your parents/parents-in-law
Nanny
Other (supports):
What would you like to see more of? Check everything that applies.
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Cooperation
Respect
Independence
Joy
Harmony
Peace
Time
Love
Other (what would you like to see more/less of?):
Please share your story. What is your biggest parenting struggle and why is it important to take action now rather than a year from now?
How serious are you about creating positive change for your family?
Just Curious
Somewhat Serious
Serious
Extremely Serious
What's do you like best about Creating Champions For Life so far?
