Permission for Counseling Services
**Please complete one form per child enrolled**
This form is intended to be used if you have concerns that you would like us to address in the school setting. At the Avalon Stone Harbor Schools, a wide range of supportive services are available to assist our students. Counseling Services can help children develop social skills, work through social/emotional issues, and help support the learning experience in school. Meetings with the School Counselor / School Psychologist occur during school hours and are coordinated with the teacher(s) to minimize interruption to instruction time or inhibit schoolwork/progress.
  • Please understand that counseling is confidential, and we respect your child's right to privacy (see below for more information regarding confidentiality standards). 
  • We STRONGLY encourage you to discuss counseling progress with your child and incorporate positive strategies learned into your child's daily routine.
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Student's FIRST Name *
Student's LAST Name *
Student's Grade *
I hereby confirm that I am the legal parent/guardian of the student listed above and affirm that I have signature rights and may give consent. *
By electronically signing (typing in) my full name, I hereby give my informed consent for my child to participate in school-based counseling services at Avalon Stone Harbor Schools.
(Please type your full name)
 *
Best method of contact if needed. *
Required
Please provide the contact information to best reach you (e.g. phone number, email address, etc.): *
*OPTIONAL*   
My primary concerns (please check all that apply):
*OPTIONAL*
Any additional information regarding your concerns:
*OPTIONAL*
Please share some of your child's strengths:
Please read the following information pertaining to School Based Counseling:
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