Communities In Schools (CIS) Parent Consent Form
Welcome Parents/Guardians! At Communities In Schools (CIS), our mission is to surround students with a community of support, empowering them to stay in school and achieve in life. During a typical school year, you would receive a physical parent consent form to sign to give permission for your student to participate in the CIS program. However, as I am sure you know well, this school year is very different. In order to adapt to changes, parents/guardians may fill out this form to provide permission to for students to participate in the CIS program.
Please note:
Filling out this form does not guarantee that your child(ren) will be enrolled in the CIS program. You will be contacted if/when your student is enrolled in the CIS program before services begin.

If your student is enrolled into the CIS program, you will receive a physical parent consent form to sign that will be required at a later date.

If you have more than one student that you wish to be in the CIS program, please fill out an individual form for each additional student.
Parent/Guardian Name *
Student Name *
Today's date:
What service(s) would most benefit your child? *
Choose up to two responses.
I give permission for my child to participate in the Communities In Schools (CIS) program for the 2020-2021 school year. *
Services my child may receive include but are not limited to supportive guidance/counseling, educational support, tutoring, mentoring, enrichment activities, referrals to other agencies.
I consent to CIS providing support to my child and/or family via telehealth which can include, but not limited to: text, Zoom, Google Classroom and other similar technology. *
I further understand that there are risks unique and specific to Telehealth, including but not limited to, the possibility that the Telehealth sessions with my site coordinator could be disrupted or distorted by technical failures or could be interrupted or could be accessed by unauthorized persons.
Please leave any additional questions, comments, or concerns below.
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