Bonner ES Parent Permission for Counseling

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Date *

YYYY

Student name (first and last) *

Teacher's name *

Grade Level *

Your child would benefit from individual/small group assistance in the areas below: *

Assist with Character Building

Study Skill/Academic Services

Following School/Classroom Rules

Getting Along with Others

Friendship Skills

Resolving Conflicts/Problem Solving Strategies

Coping Skills

Support for children of change

Behavioral Management

Anger Management

Social Skills

Other:

Required

Other information you think Ms. Kaskie would need

In order to counsel and converse with your child, it is mandatory that this form be signed. Please feel free to call Ms. Kaskie regarding any questions/concerns you may have. 702-799-6050 ext. 4301 Please type your full name below to indicate your signature. *

Daytime phone number *

Parent email address *

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