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Kyrene School District Parent Consent for School Counseling Services
Dear Parent(s)/Guardian:

Your child has been referred to school based counseling services which may include individual or group counseling and/or family support services. School based counseling services differ from community therapy as school counseling is generally short term and focused on finding success at school. School counseling is not on-going therapy, diagnosis, or treatment for specific mental health conditions.

Information shared by students is confidential. The student’s right to privacy is guarded as much as permitted by law, ethics, and school policy. The person providing school-based counseling services is obligated to maintain confidentiality unless there is clear and imminent danger to the student or others or when legal requirements demand that confidential information be revealed.

Should you have any questions regarding this consent form, please do not hesitate to contact me, Kara Ashcraft, at (480)541-4777 or email me at kashcraft@kyrene.org. Your immediate response is appreciated.

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Email *
Student Name *
Student Grade *
I agree to allow my child to participate in school-based counseling support through the Kyrene School District.  I understand that the laws that protect the privacy of student educational records, including FERPA, apply to the virtual delivery of counseling services and I understand that I can withdraw my consent at any time by providing a written signed request to the district.  I understand that there will be no cost to me.  Should my child need additional help that cannot be offered through school-based counseling services, I will be contacted and provided additional resources. I have read and understand the information provided above regarding the delivery of counseling services and have been given the opportunity to discuss it with the counseling provider if desired. By clicking below, you are confirming your consent for school counseling services. You also acknowledge that you are a parent (per birth certificate) or legal guardian (per court order) and have educational rights to make this choice for this child. *
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Parent/Guardian Name *
Today's Date *
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