Program Registration Form

To register for an upcoming course or program, please complete the form below.

UPCOMING COURSES & PROGRAMS

The Blueprint for Your Future Workshop
(Ages 18+)

Fridays beginning June 5th
6:00pm - 7:00pm

The Blueprint for Your Future Workshop is a 10-week journey for young adults and anyone who is ready to gain clarity and direction in their lives. This experience helps participants strengthen self-awareness, build confidence, and develop a meaningful plan for their future. It’s designed to meet individuals where they are and guide them toward a more focused, intentional path forward.

* REGISTRATION ENDS MAY 29TH *

PARTICIPANT INFORMATION

Full Name

First NameLast Name

Age

Phone Number

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

Email Address

example@example.com

ADDITIONAL PARTICIPANT

If there is another participant joining you, please provide their information below.

Do you have someone joining you? Yes or No

Full Name

First NameLast Name

Age

Phone Number

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

Email Address

example@example.com

MEDIA CONSENT & RELEASE

I give permission for NiQ Life Coaching to take and use photos or videos of me for promotional or educational purposes (such as social media, website, or newsletters).

I understand that I will not receive any monetary compensation for the use of these images.

I grant NiQ Life Coaching the right to edit, publish, or distribute these photos for any lawful purpose.

I understand I can revoke this consent at any time by providing written notice to the program facilitator.

PROGRAM AGREEMENT
The Blueprint for Your Future Workshop
______________________________________________________________

Program Duration
This program will run for a total of 10 weeks. Each session is intentionally structured to build on previous sessions, supporting personal growth and development throughout the experience.

Days/Times
Sessions will take place weekly on Thursdays at 6:00 PM. Each session will last approximately one hour. Participants are encouraged to arrive on time to fully engage in each session.

Payment Terms
Full payment is required prior to the start of the program to confirm enrollment. Space is limited and will be reserved only upon receipt of payment.

Attendance Expectations
Participants are encouraged to attend all sessions, as each week builds upon the last. Consistency will enhance the overall experience and outcomes.

If a session must be missed, participants are asked to notify in advance via email or text. While sessions are not repeated, the facilitator will be available up to 15 minutes before each session for brief support or questions regarding missed content. Participants may also reach out via email for additional guidance.

No Refund Policy
All payments are non-refundable once the program has begun, due to the limited enrollment and commitment required for the full experience.

Behavior Expectations
Participants are expected to:

~ Engage respectfully with the facilitator and other participants
~ Be present and actively participate in discussions and activities
~ Minimize distractions, including phone use during sessions
~ Contribute to a positive, supportive, and growth-focused environment

Liability Waiver
By enrolling in this program, participants acknowledge that they are voluntarily engaging in personal development activities. The facilitator and hosting facility are not liable for any injuries, losses, or damages that may occur during participation.

Acknowledgment
I, the undersigned, acknowledge that I have read and understand the terms and expectations outlined in this agreement for The Blueprint for Your Future Workshop. I agree to the program policies, including payment terms, attendance expectations, behavior guidelines, and the no refund policy.

I understand that my participation is voluntary and that I am responsible for my own engagement and progress throughout the program. I also acknowledge and accept the liability waiver.

Participant's Signature

Date

2nd Participant's Signature

Date

PAYMENT

The Blueprint for Your Future Workshop
____________________________________

10-Week Workshop Fee:
$199 per participant
$249 for 2 participants

*Includes one workbook per participant

This is a one-time fee covering all 10 sessions.

My Products

The Blueprint for Your Future Workshop - Single Registration

1 Participant - Ages 18+

$199.00 Quantity

The Blueprint for Your Future - Group Registration

2 Participants - Ages 18+

$249.00 Quantity

Total

Signature

Date

How did you hear about us?

Please send your questions or concerns to taniqua@coachniqspeaks.com.

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.