Thank you for booking your consultation with LeSel!
To help me prepare, please answer a few questions about your child.
Child's first name: {"type":"text","name":"childName","width":60,"value":"","size":"Normal","validation":"NE","validationMessage":"Please enter your child's name","placeholder":"Please enter your child's name"}
Child's age: {"type":"text","name":"childAge","width":50,"value":"","size":"Normal","validation":"TI","validationMessage":"Please enter a number.","placeholder":"Please enter your child's age"}
Which area interests you most?
Please choose...Sports & Athletic PerformanceKids & School (Focus, Organisation, Learning)Family Dynamics & RoutinesNot sure yet{"type":"select","name":"pillarInterest","width":100,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Please choose...\nSports & Athletic Performance\nKids & School (Focus, Organisation, Learning)\nFamily Dynamics & Routines\nNot sure yet"}
School or sport details:
{"type":"text","name":"schoolSport","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","placeholder":"e.g. St Julian's School, Year 4 / Competitive tennis, 3x per week"}
Main concern:
{"type":"textarea","name":"mainConcern","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please tell me a little about what's going on","height":150,"placeholder":"Tell me briefly what's happening — there are no wrong answers"}
How did you hear about LeSel?Please choose...Google searchSchool recommendationFriend or family referralSocial mediaSports club or tournamentOther{"type":"select","name":"hearAbout","width":100,"value":"","size":"Normal","validation":"N1","validationMessage":"Please make a selection for this item.","options":"Please choose...\nGoogle search\nSchool recommendation\nFriend or family referral\nSocial media\nSports club or tournament\nOther"}
Anything else:{"type":"textarea","name":"anythingElse","width":100,"value":"","size":"Normal","validation":"","validationMessage":"Please fill in this item.","height":150,"placeholder":""}
Consent (required for participants under 18)
{"type":"checkbox","name":"consentParent","width":100,"value":"","size":"Normal","validation":"CA","validationMessage":"Please check all of the above.","options":"I am the parent or legal guardian of the child named above and give permission for them to participate in brain coaching sessions and/or workshops with LeSel.\nI consent to the processing of my child's personal data for coaching purposes in accordance with LeSel's privacy policy (lesel.ai/privacy).\nI understand that brain coaching is not therapy or medical treatment."}
By typing your full name below, you confirm that you are the parent or legal guardian and agree to the above.
{"type":"text","name":"parentSignature","width":100,"value":"","size":"Normal","validation":"NE","validationMessage":"Please fill in this item.","placeholder":"Full name"}