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School Counseling Consent Form

Leadership Military Academy School Counselor(s) offer short-term individual counseling to students, as well as small group counseling. These services are aimed at the more effective education and socialization of the student within the school community. These services are not intended to substitute for diagnosis or treatment for any mental health disorder. Parent(s)/guardian(s) or school staff may refer students for counseling, or students may request counseling for themselves. To build trust with the student, the school counselor will keep information confidential, with some exceptions. Because these services are provided to minors in the school setting, the School Counselor may share information with parent(s)/guardian(s), the student’s teacher, and/or administrators or school personnel who work with the student on a need to know basis, so that they may better assist the child as a team. The counselor is also required by law to share information with parent(s) or others (i.e. law enforcement, proper legal authorities, etc.) in the event the student is in danger of harm to self or others or if child abuse is suspected. The counselor will make the child aware, in age appropriate manner, of these limits to confidentiality and will inform the child when sharing information with others.
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By signing this document, I give consent for my child to participate in school counseling services.

I am the legal parent/guardian, and have read, understand, and agree to the terms of this School Counseling Consent. I give permission for my child to receive school counseling services at this school for the current school year 2024-2025.  I understand that I may withdraw my consent at any time by signing and dating a written note requesting
termination of counseling services.
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