Counseling Opt In/Out Form

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Counseling Opt In/Out Form

Dear Parents,

From time to time, we may have access to counseling (therapy) services on campus. In order to serve your children with such services, we need to ask for your approval to have your child talk to a therapist. Using this form, please either Opt In or Opt Out. This is a completely oiptional service.

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* Indicates required question

Email *

Your email

Child's Name (Please fill out separate form for each child) *

Your answer

I consent to allowing my child to talk to an on campus therapist/therapist intern. *

Yes

No

Any questions? Please write them here.

Your answer

Submit

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