Parent Intake Form | Peak Performance Coaching

Parent & Athlete Info

Tell us about you and your athlete

Step 1 of 5

About You

Your Full Name* Please enter your full name.

Relationship to Athlete* Please select your relationship to the athlete.

Email Address* Please enter a valid email address.

Phone Number* Please enter your phone number.

Preferred Contact Method*

Email Phone Call Text

About Your Athlete

Athlete's Full Name* Please enter your athlete's full name.

Athlete's Age* Please enter your athlete's age.

Sport(s)* Please enter your athlete's sport(s).

Grade Level / School

Competition Level

Step 1 of 5

Current Concerns

What you're noticing in your athlete right now

Step 2 of 5

What's Going On

Select anything you've noticed in your athlete lately: It's okay if several apply — this just helps us understand where to start

Describe what you're noticing, in your own words* Please describe what you're noticing.

When did you first start noticing this?

Step 2 of 5

Goals for Coaching

What you're hoping this experience will do for your athlete

Step 3 of 5

Hopes & Timing

What would success look like for your athlete after working with a mental performance coach?* Please describe what success would look like.

Is there a specific event, season, or goal driving the timing of this request?

Previous Mental Performance Work

Has your athlete worked with a sport psychologist, mental performance consultant, or done mental skills training before?

Yes No

Briefly describe that previous experience — what worked, what didn't

Step 3 of 5

About Your Athlete

Help us understand who they are beyond the scoreboard

Step 4 of 5

Life & Personality

What does your athlete enjoy outside of their sport? (hobbies, interests, activities)

Is there anything about your athlete's personality, learning style, or communication preferences that would help us work with them effectively?* Please answer this question.

Anything else you'd like us to know before the first session?

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Logistics & Consent

Scheduling details and parental authorization

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Scheduling & Availability

Preferred Days / Times

Session Format

Best Contact Method

Consent & Acknowledgment

Parent / Guardian Typed Signature* Please type your full name to sign.

Date

All information provided is kept strictly confidential and used solely to support your athlete's mental performance coaching experience.

Step 5 of 5

Parent & Athlete Info

Current Concerns

Goals for Coaching

About Your Athlete

Logistics & Consent

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