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Registration Form - Living Education Coaching

* Fill out and submit the pre-screening form and, if accepted, you will receive an email with 24 hours.
What brings you to seek support today, and how long has this been on your mind?

Are you ready to hear truths that may be uncomfortable about the way you raise your child?

A
B

Age(s) of the child(ren)?

Are you ready to question your own way of being a parent, not just your child’s?

A
B

Which structured support package—with an adult aged 18 or older via Zoom, consisting of one two-hour session per week—is the best fit for you: the 3-month package for $3,900 USD (13 sessions) or the 6-month package for $7,020 USD (26 sessions)?

A
B

Can you briefly describe your child’s current family structure and what is your relationship situation as a couple?

How many hours per week do you estimate your child spends in front of a screen, combining phone, tablet, video games, or computer?

What role does the spiritual or religious dimension play in your family’s daily life?

If you’d like, you can share any information here regarding your child’s health or development that might help me better support you.

Are you with the media, an event, or an organization, and would you like to invite me as a speaker or presenter? Tell me more here.

Your email address

Do you have any questions?

Your full name

Legal Aspects

Limits of the coach’s role: The Living Education coaching offered here is educational guidance, not a mental health service. The coach is neither a psychologist, nor a therapist, nor a physician, and does not provide any diagnosis. If a mental, physical, or psychological health issue is identified during the guidance process, the educator will be referred to an appropriate qualified professional. The coach is in no way a substitute for professional mental health follow-up that is already in place or needed.
Payment and cancellation: Payment for the two-hour block is due no later than 48 hours before the scheduled session. Any session not paid within this timeframe may be postponed or cancelled. No refunds are offered, regardless of the reason for cancellation or the client’s absence, except in a justifiable case of force majeure. The Living Education coach reserves the right to cancel a session at any time. The educator will be notified as soon as possible. In such a case, the session will be rescheduled to a date agreed upon by both parties, at no additional cost to the educator.
Recording of sessions: For the sake of mutual protection, every session held on Zoom is recorded. This recording is used exclusively for professional follow-up purposes and the legal protection of both parties in the event of a dispute. It is neither shared, nor distributed, nor used for any other purpose without explicit consent.
Confidentiality and data security: All personal information shared as part of Living Education coaching — including recordings, notes, and communications — is treated as strictly confidential. It is never disclosed to third parties and is kept securely, in accordance with applicable personal information protection laws.
Limitation of liability: The Living Education coaching offered is intended to support the educator’s reflection and decision-making. Any decision made by the educator as a result of this guidance — including, but not limited to, choices regarding schooling, discipline, or family organization — is the educator’s sole and entire responsibility. The Living Education coach cannot be held liable for the consequences of these decisions.
Mandatory disclosure (reporting): Like any person working with children, the Living Education coach may be legally required to report to the appropriate authorities any situation suggesting that a child is in danger or that their safety or development is compromised. This obligation takes precedence over the confidentiality commitment set out in these terms.
Applicable law and dispute resolution: These terms are governed by the applicable laws of the province of Quebec and of Canada. In the event of a dispute, the parties agree to seek an amicable resolution in good faith, notably through mediation, before pursuing any legal action.

By checking the box below, I confirm that I am eighteen years of age or older, and I acknowledge that I have read, understood, and accepted without reservation all of the conditions stated above, and I commit to fully complying with them. This consent constitutes a firm commitment on my part.

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* If accepted, you will receive an email within less than 24 hours.