Back 2 The Basics: LeadHER Legacy Youngstarz Vibe Workshop Series for Girls (Ages 13

How did you hear about this program?*

Youth Name*

First NameLast Name

Participant's Age*

Participant's Date of Birth*

Date

Participant's Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Participant's Email Address*

example@example.com

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

School*

Grade Level*

Expected Graduation Year*

Student's Hobbies*

i.e. sports, music, poetry, video games, etc.

What do you hope to gain from this workshop series?*

How would you describe the youth participant's personality?*

What are the participant's biggest strengths?*

What challenges does the participant face at school, socially, or emotionally?*

Do you have any concerns or questions you'd like to discuss before the program begins?*

Does the participant have access to a computer and reliable internet connection to join this program?*

YesNo

Does the participant have any allergies, medical conditions, or special needs we should be aware of?*

Parent/Guardian's Name*

First NameLast Name

Parent/Guardian's Phone Number*

Please enter a valid phone number.Format: (000) 000-0000.

Relationship To Participant*

Payment Method*

By checking the following boxes and signing this form, I agree:*

By enrolling in the program, you give permission for your child to be photographed or recorded during sessions or events for promotional, educational, and social media purposes, unless otherwise noted on your registration form.Participants are expected to follow rules of respect, cooperation, and safety. Repeated disruptive, unsafe, or disrespectful behavior may result in temporary or permanent dismissal from the program at the discretion of program leadership."Back to the Basics" does not provide transportation services unless otherwise specified. Parents/guardians are responsible for ensuring safe and timely arrival and departure from all program activities.This program is not a substitute for medical, psychological, or therapeutic services. If your child requires professional care, please consult with a licensed healthcare provider. Staff and mentors are not licensed clinicians and will not administer medication or provide medical care.The "Back to the Basics" Youth Mentoring Program is designed to provide guidance, education, and positive mentorship. While we aim to offer a safe and encouraging environment, participation in the program does not guarantee specific outcomes. Parents and guardians remain ultimately responsible for the well-being and supervision of their child outside program hours.While mentors will respect the privacy of participants, confidentiality cannot be guaranteed in cases where there is a concern for the safety or well-being of the youth or others. In such cases, appropriate authorities may be notified.

Parent/Guardian Signature*

Date Signed*

Date

My Products

Back 2 Basics LeadHER Vibe Workshop Series Deposit

Total investment is $2500. Coach K is currently offering the 7 series workshop program package at $450. This includes digital workbook, Back 2 Basics T-shirt, 7 virtual sessions, and Certificate of Completion. All payments are non-refundable. Only 20 slots available for each session. First come, first serve. Cohort starts

$450.00

LeadHER Legacy YoungSTARZ Session 1: Confidence & Mental Strength

$85.00 Quantity

LeadHER Legacy YoungSTARZ Session 2: Own Your Voice: Lead The Future (Public Speaking & Mastering Your Elevator Speech)

$85.00 Quantity

LeadHER Legacy YoungSTARZ Session 3: The Power of Active Listening

$85.00 Quantity

LeadHER Legacy YoungSTARZ Session 4: Finding Your Purpose-Identifying Your Unique Strengths & Talents

$85.00 Quantity

LeadHER Legacy YoungSTARZ Session 5: Balancing Time School & Life

$85.00 Quantity

LeadHER Legacy YoungSTARZ Session 6: Building Your Customized LeadHER Legacy Toolkit (Vision Mapping)

$85.00 Quantity

LeadHER Legacy YoungSTARZ Session 7: Shine Beyond The Series: Becoming The Legacy

$85.00 Quantity

Total

$0.00

Payment Methods

Fastlane Checkout

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Contact Info

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Back 2 The Basics: LeadHER Legacy Youngstarz Vibe Workshop Series for Girls (Ages 13–19)

Empowering young girls to lead, grow, and thrive—one session at a time.

Ready to invest in the next generation of confident, purpose-driven young women?

Parent/Guardian Information

Payment Details

Back 2 The Basics: LeadHER Vibe Workshop Participant Agreement