Faith-Based Youth Counseling Consent Form

Youth Information

Full Name Date of Birth Address

Parent/Guardian Information

Parent/Guardian Name Phone Number Email Address

Purpose of Counseling

Reason for Counseling

Consent & Agreement

I understand that the counseling provided to my child will be faith-based, integrating spiritual principles and values. I acknowledge that all information shared during counseling sessions will be treated confidentially, except in circumstances where disclosure is required by law.