(Required for young people 17 and under )
I hereby give permission for my child(ren) to receive counselling at Reach.
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Childs name (1) (BLOCK CAPITALS): |
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Date of birth: |
Age: |
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Childs name (2) (BLOCK CAPITALS): |
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Date of birth: |
Age: |
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Parent or Guardian Signature: |
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Parent or Guardian Name (BLOCK CAPITALS): |
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Relationship to child: |
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Date of signing: |
Every child is
entitled to a degree of confidentiality but as each case is different
it is
recommended that you discuss the nature of this with your childs
counsellor.
