General Permission Form to Work with Youth Services Worker (contracted by Seasons Center Full-Time).

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Seasons Center for Behavioral Health is excited for the opportunity to provide the students of Sioux Central with behavioral and mental health support. Tanya Nelson, as a Youth Services Worker, will be available in the building full-time to provide formal, on-going informal, and supportive services to students Preschool-12 grade. For more information about our new position, click here: https://docs.google.com/document/d/1QyFX8wFEp1y-M2cr3ZnzuHUED7EPhOYx/edit?usp=sharing&ouid=113161564605510395245&rtpof=true&sd=true.

Please fill out form below for every child you have in the building, giving permission for your child to work with Tanya, as needed, in immediate situations. If Tanya and the school feel she needs to see a student regularly or more formally, she will contact you and have other forms that need to be filled out!

Last Name *

First Name *

Date of Birth *

YYYY

I give permission for Seasons Center for Behavioral Health to perform individual or group skills-based services with my child and share information with Sioux Central to help my child be more successful at school, community, and home. *

Check Here to indicate Signature/Consent

Required

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