Belmont-Redwood Shores Remote Counseling Request & Telecounseling Consent
Students and families please use the below form for support from school counselors.
Concerns may include:
-Child/student is having a hard time coping with the temporary changes being made in response to COVID-19
-Child/student is in need of emotional support - showing signs of sadness and worry
-Child/student expresses a desire to talk with the school counselor
Please note, if you or your child are experiencing an urgent mental health concern or emergency you should call 911 or contact San Mateo County Mental Health hotline at (800) 686-0101.
I am a....
Student Last Name
Student First Name
Parent/Guardian Last Name (if form completed by guardian)
Parent/Guardian First Name (if form completed by guardian)
Student Grade Level
Urgency of Need
Contact me when you can
I have an urgent need *recommended to call 911 or county mental health hotline at (800) 686-0101
Nature of Concern
My child is having a hard time coping with the temporary changes being made in response to COVID-19.
My child is in need of emotional support (showing signs of sadness, worry, etc.).
My child expresses a desire to talk with a school counselor.
Parent/Family member would like to talk with a school counselor.
Briefly expand on the nature of your concern and what type of support you are looking for from the school counselor.
Preferred Response Type
Virtual (Google Hangout, Zoom, etc.: we will need the below consent form signed for this)
Contact information (phone and email)
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This form was created inside of Belmont Redwood Shores K-8.