| DENVER /PUBLIC | SCHOOLS Diacover a World oF Opportunity” Denver Public Schools Guardian Consent for Counseling Services Stud ‘ ID: Schc Grac LZ @BecentGuardian, rely give permission for Denver Public School's School Psychologist Intem, finda» Albert? ___to see my child for individual or group counseling. | understand that the purpose of the counseling is to enhance my child’s academic performance and/or social emotional skills. The counseling goals have been explained to me by the School Psychologist Intern and are briefly outlined below: Goals of Counseling: Séall_ 9/o i of Simbp-e ps focal on Pack Strtesdes for _conlealln, sMpaltec, Da\italaies teas, ent terantediny frecsochs! beheniy~ cilbn Ne [. A, I understand thatthe above services will be provided during the current academie year and my C'S consent to services may be withdrawn by me at any time. Guardian Signature ____ Date: oC ‘School Psychologist Intern Signature Chu aller Date:_Il /2O / A anne cent rn nant rami Denver Public Schools Revised August 2014 Page 1Denver Public Schools Guardian Consent for Counseling Services Studer ID: School Grade: 1 __(Parent/Guardian, freely give permission for Denver Public School’s School Psychologist Intern, to see my child for individual or group counseling, I understand that the purpose of the counseling is to enhance my child’s academic performance and/or social emotional skills. The counseling goals have been explained to me by the School Psychologist Intern and are briefly outlined below: Goals of Counseling:_ Syl with Saee-~age. Sto cahyee_Jirfulte Contr! ant ability to "int fescocish, ah olka | understand that the above services will be provided during the current academic year and my consent to services may be withdrawn by me at any time. Guardian Signature _ Date: 243 /Id ‘School Psychologist Intern Signature Cub alk pae:_!2/U/ IY Denver Public Schools Revised August 2014 Page 1DENVER PUBLIC SCHOOLS Denver Public Schools Guardian Consent for Counseling Services Studen ID: & School Grade: LL __ (Parent/Guardian), freely give permission for Denver Public Schoor's School Psychologist Intern, An Lileck? — to see my child for individual or group counseling, I understand that the purpose of the counseling is to enhance my child's academic performance and/or social emotional skills. The counseling goals have been explained to me by the School Psychologist Intern and are briefly outlined below: Goals of Counseling:_(tall h Maplar— Goalarn as IeSlon( ent (le flying acBiviiiel diel to ‘tesch [mfalte conlroly 2 well ac enue Goal nd obiilily © thal T understand that the above services will be provided during the current academic year and my consent to services may be withdrawn by me at any time. Guardian Signatare Date: 2/4 14 School Psychologist Intern Signature _ Ch oles pae:_12/ 4/4 Denver Public Schools Revised August 2014 Page 1