PVUESD Counseling Permission Form
Dear Penn Valley Union Elementary School District Parents and Families:

Counseling is a service that is offered by the district and requires written permission from parents each school year. This is a permission slip for counseling services valid through the 2022/23 school year. If you feel comfortable, please continue to fill out this form and I will keep it on file.  

Please know that I will NOT begin any ongoing counseling services without contacting you by phone and receiving verbal permission to begin. Filling the paperwork out ahead of time is completely up to you and your comfort level, and is only intended to save time on one step in the process.

If you have any questions regarding the permission slip form or counseling services in general, please do not hesitate to contact me.  Thank you!

Lindsey Romero, PPSC
(530) 432-1118 x2224
lromero@pvuesd.org

Students First Name *
Students Last Name *
Students School: *
My child has permission to participate in the counseling services, in either a one to one or group setting, provided in Penn Valley Union Elementary School District by the School Counselor, Lindsey Romero. I understand that all information shared by students is confidential, barring safety concerns. This permission slip is valid during the current school year of 2020/2021. Counseling services will commence upon approval of the date noted on this form. Student services provided by the counselor are evaluated on an as-needed basis and may not continue throughout the entire school year. *
Parent/Guardians First Name: *
Parent/Guardians Last Name: *
Phone Number: *
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