Mindful Adventures Saturday Clubs

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Getting Started Mindful Adventures

• What is the name of the child?*
• What is their age?*
• What are their challenges or struggles?
• What are your challenges or struggles in supporting your student?
• What goals would you like your student to achieve?
• What goals would you like to achieve yourself in being able to support your student?
• What zip code are you located in?*
• Names of the parents? (first/last)
  First Last
• Which program or services you are you interested in?*
  • Private Tutoring + Coaching
  • Online Tutoring + Coaching
  • Homeschool Support Services
  • Executive Functioning Coaching
  • Parent Coaching
  • Child or Family Therapy
  • Summer + Winter Camps
  • Executive Functioning Groups
  • Mindful Adventures Clubs + Camps
• How did you hear about Club Xcite
  • Search Engine
  • Facebook Posting
  • Referred by another professional
  • Referred by a client
  • Your child's school
• Name of referring professional. (if applicable)

• Who should we contact?

• Who should we contact?*
  First Last
• Phone Number*
• What is the best time of day to call you?
• Email Address*
• Is there any other information you would like to share with us?
• Phone
  This field is for validation purposes and should be left unchanged.