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Banks Counseling Group Permission
Ms. Hult, School Counselor
Ashley.Hult@tusd1.org
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Counseling Groups will meet on Zoom during child's lunch or recess once a week. For individual counseling (one-on-one), please submit a referral or call or email me.
Child's Name
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Your answer
Person Signing
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Your answer
Relationship to child:
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Your answer
Group:
Socialization & Friendship
Self-Control/Anger
Grief, Sadness, Coping Skills
Stress/Anxiety/Worry
Virtual School Success Skills
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I understand that groups are confidential and will do my best to provide participants with privacy.
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I understand and agree
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I understand that Ms. Hult will keep group content confidential, except in the following circumstances: student expresses harm to self or others, student is in danger
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I understand
I understand that there may be limits to confidentiality, given the distanced-based nature of this group
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I understand
What I'd like my child to gain from group (optional)
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Notes (optional)
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Electronic Signature
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Contact info:
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