Please complete a separate intake form for each participant :)

Child's Full Name *

Parent's Full Name *

Parent's email (event logistics will be sent here) *

Child email (optional)

Parent Phone Number *

Child’s phone number (optional)

Child's Date of birth *

Your Street Address *

City *

State *

Country *

Zip code *

Is this your first Young Teens Mastermind or are you a returning alumni? *

How did you hear about this event? (If it was a person, please mention their name *

Questions For Your Child:

Do you find yourself to be more introverted or extroverted? *

Why do you want to be part of this transformational young teens mastermind? *

Which part of the mastermind are you looking forward to most? *

What is your biggest hope for attending this event? *

Questions For Parent:

Why do you want your child to be part of this young teens transformational mastermind? *

What is your biggest hope your child will get out of this event? *

Are you attending with anyone? If so, who? *

Do you have any dietary restrictions or food allergies? (Please specify) *

Declaration *

Do you consent to being photographed or recorded during the event for marketing or educational purposes?

I acknowledge and agree to the event's terms and conditions, including the cancellation policy