The Manifest Your Soul Dream Experience - Intake Form

Intake Form - The Manifest Your Soul Dreams & Epic Results Experience

First Name

Last Name

Phone/Mobile

Facebook Name/Handle (Note: Please also add ‘Kay Z Zakrzewski as a friend if you’re not already friends on Facebook)

Address

Address Line 1

Address Line 2

City

State

Zip Code

Country

Birth Day

FULFILLMENT QUESTIONS

The following questions are specifically worded to evoke curiosity, wonder and intention with regards to your participation in The Manifest Your Soul Dreams & Epic Results Experience.

Please write down the answer that first comes to mind, no holds barred. Do not judge what you write; instead, let it flow through you. You might actually be surprised by what you say!

This Experience will result in the fulfillment of what you write below.

What’s something that’s felt out of reach that you deeply want to bring to life by participating in The Manifest Your Soul Dreams & Epic Results Experience? Where or what do you see you most want to change?

Why might you want to change (to have it be different than it currently is)?

How ready are you to change (to have it be different than it currently is)? Where ‘1’ means ‘Not Ready’ and ‘10’ means ‘Totally Ready.’

Why didn’t you pick a lower number?

Imagine you have changed, you've cleared your blockages and transcended your limits in this Experience, what would the positive outcomes be?

Why are those outcomes important to you?

What soul-aligned results or breakthroughs would make this Experience wildly successful for you? What do you want to feel more of in your life by the end of this program?

GETTING TO KNOW YOU QUESTIONS

What are you currently doing to support your mental, emotional, or spiritual well-being?

What’s calling you to Manifest Your Soul Dreams & Epic Results right now?

When you’re facing a challenge, how do you typically respond or move through it?

This Experience is fast-paced, growth-focused, and soul-aligned. What makes you feel ready for that right now?

How do you see you will sabotage your success in this Experience? What will predictably take you out?

What are you most proud of accomplishing in your life or career so far?

Is there anything else you’d like to share to help me support you during this Experience?

How’d you find out about us? If it was someone who told you, what’s their name so I can say thank you!

LIABILITY WAIVER & CONFIDENTIALITY AGREEMENT FORMS

After you submit this form, you will be redirected to a page where you can sign a Liability Waiver and Confidentiality Agreement. You are not considered approved for the program until these forms are signed.

Thank you.