10-11 Fall Counseling Group Parent Permission Form - Puyallup

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10-11 Fall Counseling Group Parent Permission Form - Puyallup Powered By Docstoc
					           Counseling Group Permission Form
Date: October, 2010

From: Jackie Bridges, Firgrove Elementary School        (253) 841-8733

Dear Parent/Guardian,
Small group counseling is an excellent way for students to learn new skills,
develop self-confidence, become more aware of how others see them,
practice new behaviors, and better understand how to deal with the many
challenges life presents. In most cases, your child has referred him/herself
to one or more small counseling groups, which will focus on:

Anger management – for students whose temper interferes with success at

Self-esteem/Leadership – for students wanting to develop more confidence and good
feelings about themselves (with community/Firgrove leadership opportunities)

Girl Power – (5th and 6th grade girls only) – for students dealing with friendship,
emotions, “drama” and relational aggression (we will be watching part of a PG-13 movie
called Mean Girls for this group to facilitate some discussions)

Friendship Skills – to help learn how to make & keep friends and develop strong
communication skills

Separation/Divorce – to strengthen coping strategies that assist in dealing with changes in
family structure

Small counseling groups take place during the school day at a time that is least
disruptive to the students’ academic process (usually during half of lunch and
half of recess). Please complete this consent form, either granting or denying
permission for your child to participate in these group(s). Students may
participate in no more than TWO groups per school year. Depending on the
number of forms returned, some groups may begin in 2011.

Please Return the attached form to Firgrove’s counselor on or before
Friday, October 22nd. Thank you.

                                  (SEE REVERSE SIDE)
                         Counseling Group Permission Form

I, _____________________________________________________,
       Please Print Parent Name Clearly

Parent of ________________________________________                   in Grade _______
             Print student’s name clearly

Teacher’s name: ___________________________

(**Circle one):            I             DO            or     DO NOT
Give my consent for my child to participate in the small counseling group(s) listed on the
reverse side of this form.

______________________________________                        _________________
Parent Signature                                                   Date

Please return to the Firgrove Elementary Counselor on or before:

Friday, October 22nd, 2010

**Please be certain that you remembered to circle above, indicating whether or
not your child has permission to participate. **

Thank you,

Mrs. Jackie Bridges, M.Ed.
School Guidance Counselor
Firgrove Elementary

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