Consent for a Minor to attend Counselling
Child’s First Name
Child’s Last Name
Child’s Date of Birth
YOUR Full Name
YOUR Relationship MotherFatherLegal Guardian
YOUR Email Address
YOUR Phone Number
OPTION 1OPTION 2OPTION 3
OPTION 1 = Parents are married
OPTION 2 = Parents are separated or divorced and I am the parent with sole legal authority to consent
OPTION 3 = Parents are separated or divorced and I do not have sole legal authority to consent. I understand that consent is also required from the other parent and will forward this link to them because we share custody.
I confirm and acknowledge the following:
I am the parent/legal guardian of the child named above and give my consent for counselling at FMC.
In shared custody cases, consent from both parents is required and I will forward this link to the other parent where necessary.
I understand that the email addresses provided will be used for communication related to my child’s care, such as appointment reminders, invoices, and child updates.
I acknowledge that all communications, including the email addresses used, will be visible to all parents/guardians and relevant parties involved in my child’s counselling.
I have read and agree to the above consent statements.
