Toileting Consent Form

Consent Form for Assisting with Toileting Needs During Session

Version: 2023
BAC staff are committed to meeting the needs of all children and working collaboratively with families to help children achieve their toileting goals. As such, BAC staff are happy to assist children with toileting as needed and will take all reasonable precautions to ensure the safety, privacy, and dignity of each child when providing toileting assistance. Depending on your child's needs, this may include tasks such as diaper changing, helping a child access the toilet, assisting a child with wiping or managing clothing, assisting a child with hand washing, and/or changing a child following an accident.
Please indicate your preference by checking the appropriate box below:*

I give consent for BAC staff to assist my child with toileting as needed. If my child is not yet potty trained or is prone to accidents, I will send them to their appointment with extra briefs/diapers and clothes.I do NOT give consent for BAC staff to assist my child with toileting. If my child is not yet potty trained or is prone to accidents, I understand that a caregiver will be asked to remain in the waiting room for the duration of my child's appointment(s) to assist with toileting/diaper changes as needed.
Signature of Parent or Legal Guardian*

Clear
Date*

MonthDayYear
Date
Print Name of Legal Guardian*
Child's Name*

First NameLast Name
Should be Empty:

Consent Form for Assisting with Toileting Needs During Session