Consent and Notification of Services for MCES students (PK-2nd)

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Guardians/Parents of MCES Students,

KRS 158.191, passed by the Kentucky General Assembly on 3/29/2023, requires parent/guardian consent and notification to address issues not academic related. Consent is required now to see our school counselors, mental health providers, and school nurses.

Topics covered by our school mental health providers in small groups or with individual students may include but are not limited to anxiety, depression, peer conflict, emotion management, social skills, and school-appropriate behaviors.

Once provided, consent is ongoing for the balance of this school year. Consent may be revoked and shall only be effective when you submit a written note of the revocation is received by the counseling office at the respective physical location of your student.

If you have more than one child in our district, please complete a separate form for each child.

Email *

Parent/Guardian Name *

Date completed *

YYYY

Student's Name *

Consent for Services

I GIVE CONSENT for my child to receive health services from the school medical providers AND I GIVE CONSENT for my child to receive services from the school counselors/mental health providers.

I DO NOT give consent for my child to receive health and/or mental health services. (Note: the withholding of consent does not prevent your child from receiving first aid, emergency health services, or emergency mental health services.)

Child's Teacher *

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