Counseling informed consent

SCHOOL COUNSELING INFORMED CONSENT

Summit Classical Christian School offers short-term individual and group counseling to students by parent permission only. Students may sign up for a meeting (after which we will seek parent permission before setting a time for the meeting) or parents/guardians may request a meeting for their child. Some areas that may be addressed include the following: social skills, anxiety, sadness, grief, self-control, anger management, self-esteem, or spiritual discipleship.

Consent

I understand that school counseling services are short-term services aimed at more effective education and socialization within the school community. I understand that these services are not intended as a substitute for diagnosis or treatment for any mental health disorder. I acknowledge that it is my responsibility to determine whether additional or different services are necessary for my child.

To develop trust with students and families, the school counselor (Mrs. Harris) will keep information confidential, with some possible exceptions. Because these services are provided to children within the school setting, I understand that the school counselor may share my child’s progress with parents/guardians, the child’s teacher, or administrators so that we may better assist the child as a team. The counselor is also required by law to share information with parents and administrators in the event the child is in danger of harm to self or others. The counselor will make the child aware of these limits to confidentiality in an age-appropriate manner.

Mrs. Harris encourages you to contact her whenever you would like an update on your child’s progress in counseling or if you have additional input, questions, or concerns.

Student Name*

First NameLast Name

Student Grade*

I, Parent Name* , am the legal parent/guardian of Student Name* I have read, understand, and agree to the terms of the School Counseling Informed Consent.

Do you give permission?*

I give permission for my child to receive school counseling services. I understand that I may withdraw my consent at any time by signing and dating a written note.I choose to decline school counseling services for my child at this time. I understand that I may request counseling services at a later date if needed.

Parent Name*

First NameLast Name

Date*

Date