• Parent/Guardian Consent


    I, _______________________________ do hereby give consent for _______

    (Child’s Name)

    _______ to meet
    with the School Counselor.  I understand the limits of confidentiality.  I understand that I can contact the
    above mentioned with any questions or concerns I have regarding my child’s progress.  I have been notified
    that this consent is valid while my child is in attendance at Cajon Park although it may be revoked at any
    time with parent notification.


    Signature of child if over 12 years of age:___________________________          Date:________

    Signature of Parent/Guardian with Educational Rights:_____________________ Date:________

    Parent/Guardian Phone Number:____________________ Work Phone:____________________

    Child’s School:__________________________________