Counseling Consent Form

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Please complete this form to provide consent for your child to participate in individual or group counseling if the need arises.

Email *

Full Name *

Please select the grade(s) your child/children are in *

1st

2nd

3rd

4th

5th

6th

7th

8th

Required

Please list the full name(s) of your child/children *

Relationship to child/children

Mother

Father

Other Legal Guardian

Clear selection

Consent Form (Document version sent via email)

I have read and understood the consent form *

Yes

Please select one of the below options *

I give my child/children consent to participate in the TA counseling Program

I do not give my child/children consent to participate in the TA counseling Program

A copy of your responses will be emailed to the address you provided.

Submit

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