Counseling Permission Form

Counseling Permission Form

Bristol Elementary School

453-3227

Parent Request for School Counseling Services – Jere Urban

Child’s Name_______________________________________________ Date_______________________

Address______________________________________________________________________________

Phone (home/work)____________________________________________________________________

I give permission for my child to receive individual and/or group counseling

Parent/Legal Guardian Signature_________________________________________________________

Changing Family Groups

Many children are living in changing families. Whether this means that parents are separating, are divorced, there has been the loss of a parent, or that there is a new parenting partner, these changes can be difficult for children. I will be offering support groups for children in changing families. The primary purpose of the groups will be to help children to feel better about themselves and their families. These groups will be with others close in age. Confidentiality will be emphasized. If you are interested in having your child participate, please contact me (Jere Urban) at 453-3227 x 214 and set up a private talk to go over questions/concerns.  We will meet individually until a group is ready to start. If you are interested, you can use the above permission form to sign-up your child.

Community Friends/Mentor Program

Now is the best time to let me know if you are interested in a “Big Brother/Big Sister” mentor for your child. Every year many school aged “Little Brothers” and “Little Sisters” feel special, visiting and having fun with these college volunteer mentors. Please call Jere (453-3227 x 214) or stop by to talk.

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