2025 Soul care application form (Minor)

Soul Care Adolescent Consent Form & Parent Agreement to Respect Privacy
Adolescent Soul Care:
Signing below indicates that you have reviewed the policies described above and understand the limits to confidentiality.
Signature*

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Date*

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Parent/Guardian:
Check boxes and sign below indicating your agreement to respect your adolescent’s privacy:*

I will refrain from requesting detailed information about individual soul care with my child.Although I know I have the legal right to request written records/session notes since my child is a minor, I agree NOT to request these records in order to respect the confidentiality of my adolescent’s soul care.I understand that I will be informed about situations that could endanger my child. I know this decision to breach confidentiality in these circumstances is up to the Soul Care giver’s judgment and may sometimes be made in confidential consultation with her consultant/supervisor.
Parent Signature

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Date*

MonthDayYear
Date
Parent Signature*

Clear
Date*

MonthDayYear
Date
Sender
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Soul Care Adolescent Consent Form & Parent Agreement to Respect Privacy