Group Counseling Consent Form
(For Minors)
Minor Information
Minor's Full Name
Date of Birth
School / Grade
Parent / Guardian Information
Parent/Guardian Name
Relationship to Minor
Contact Number
Email Address
Purpose of Group Counseling
Confidentiality
Risks & Benefits
Consent
I have read and understood the above information and give consent for my child to participate in group counseling.
Parent/Guardian Signature
Date
Counselor Signature
Date