CAPS- Paterson Counseling Consent Form

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Email *

Student First & Last Name *

Grade *

6th grade

7th grade

8th grade

Homeroom Teacher/ Class *

Reason for Counseling *

SEL ( Social emotional Learning/ Development)

Grief

Academics

Behavior

Check ins

Other:

Parent Name *

Phone number *

I/we (parent/ Guardian) give consent for my/our (child), to receive in school counseling with a CAPS- Paterson Counseling Team Member. *I understand that Counseling sessions are confidential and will not be shared with any third party unless it pertains to Self harm, safety issues/ threats, or a signed release of information for counseling purposes. A consent form for each school year will need to be filled out. *

Yes

Required

Parent email *

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

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