PARENTAL PERMISSION FOR COUNSELLING
(Required for young people 17 and under)

This is only available in Liverpool and Chester.

I hereby give permission for my child(ren) to receive counselling at Reach.

 

Child’s name (1) (BLOCK CAPITALS):

……………………………………………………

Date of birth: …………………………

Age: ……………………………………………

Child’s name (2) (BLOCK CAPITALS):

……………………………………………………

Date of birth: …………………………

Age: ……………………………………………

Parent or Guardian Signature:

……………………………………………………

Parent or Guardian Name (BLOCK CAPITALS):

……………………………………………………

Relationship to child:

……………………………………………………

Date of signing:

……………………………………………………

Every child is entitled to a degree of confidentiality but as each case is different it is
recommended that you discuss the nature of this with your child’s counsellor.

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Click here for a printable registration Form