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Group Counseling Informed Consent for Parents

The school counseling program at North Lawndale College Prep High School offers short-term individual and group counseling to all students. Parents/guardians or school staff may refer students for counseling, or students may request counseling. North Lawndale College Prep seeks to build a united identity and strong cohesion in each of the graduating classes. One way we are seeking to build cohesion is through student leadership groups. The student leadership groups would seek to equip student leaders in the class of 2016 with the skills to positively impact their peers and effectively manage conflict when appropriate. Topics to be covered in the student leadership group include: personal leadership traits, conflict styles, seeking adult support when dealing with conflicts, building a better school climate and culture, and setting goals for peer leadership. There will be a male and female group each consisting of six students. Students and will meet a total of six times including a pre-group meeting and follow up meeting. The groups may have one joint group session depending on student preference. In order to build trust with the students, we will keep information confidential, with some possible exceptions. Because these services are provided to minor students in the school setting, we understand that we may share information with parents/guardians, teachers, and/or administrators or school personnel who work with the students on a need to know basis, so that we may better assist the students as a team. We are also required by law to share information with parents or others in the event a student is in danger of harm to self or others. The counselor will make the students aware of these limits to confidentiality and will inform the students when sharing information with others. If you would like me to share information with a third party, such as a community counselor, psychiatrist, social services worker, or pediatrician, you will need to sign an additional release of information form. As school counselors it is our responsibility to provide quality care to your student. In order to ensure that quality of care is being provided consultation with a colleague may be necessary. During this consultation, every effort will be taken to protect the identity of your student. I have read each of the following items and I understand the information that is contained in this document. I give my consent to the terms of this document and agree to enter into a counseling relationship. Students Signature_______________________________________ Date____________ Parent/ Guardians Signature______________________________ Date____________