Youth Faith-Based Counseling Consent Form
Youth Information
Full Name
Date of Birth
Address
Parent/Guardian Information
Parent/Guardian Name
Contact Number
Email Address
Consent Acknowledgement
I acknowledge that I have read and understood the information regarding faith-based counseling services and voluntarily consent for the youth named above to participate.
Confidentiality Agreement
I understand confidentiality limits and agree to counseling services as described.
Parent/Guardian Signature
Date
Youth Signature
Date