Beaufort Jasper EOC Head Start

Mental Health Consultation

Parent Consent for Mental Health Consultation

Child's Last Name:*

Child's Middle Name:

Child's First Name:*

What program option are you registering for?*

Center:*

Beaufort Jasper EOC Head Start promotes the development of healthy, happy, and wholesome children who are able to adjust well to life changes and to be socially competent children and adults. Head Start provides a mental health program that meets the needs of children and families served.

BJEOC Head Start provides Mental Health Consultation services which include:
-Classroom Observations
-Support for classroom management & positive learning environments

Your consent for Mental Health Consultation allows the program to provide the best services to support social and emotional development. Please sign and return to your child’s Head Start center.

I give consent for Mental Health Consultation services.*

I do not give consent for Mental Health Consultation services.*

Parent First Name:*

Parent Middle Name:

Parent Last Name:*

I confirm that I have read and understand this form. *

By checking this option, I choose to manually sign this form.

By checking this option, I prefer to have the system electronically sign this form for me.

----------------------------

Parent Signature

Back