Small Group/Individual Counseling Permit
The following is a list of small groups being offered. If the line is checked your child expressed an interest in the group. Some were not sure, but wanted to consider it. If the line is not checked, but you think your child would benefit from a group, please write a note beside the group. At the bottom you will find a place to sign indicating that your child can be in small group, another to indicate that they can receive one on one visits with the counselor if they wish.
___ 1. Study Skills. For those who need help with study skills. They must be willing to accept help and apply the information. Many times students say they want help, but are not willing to put the effort into changing. Those who do, find school much easier.
___ 2. Anger. For those who have a hard time handling their feelings.
___ 3. Grief. For those who are sad due to death, change in families, or moving (all these can cause grief).
Most of the group is centered around death. It can be the death of a pet.
___ 4. Peer Relations. For anyone interested in making and keeping friends.
___ 5. Family. For those who want information about separation, divorce, or other family issues. We have excellent videos and books which help children understand that they are not to blame, and that their feelings are normal. Generally, even if they do not say so, children will believe they are to blame for problems.
___ 6. Alcohol/drug Concerns. This is only for those who have a family member who has a problem that affects the family or child. They are told that it is not for those whose parents may drink occasionally. Individual sharing is not encouraged; but, rather we read books and do activities that help students deal with their feelings about this.
___ 7. Fresh Start. For students who have parents who are or have been in jail/prison. These children have a lot of questions, and because of the nature of the problem, it is not easy to get answers. Information is kept private; no information is shared unless legally required. I do not share information with teachers, etc. Often children in these situations develop learning and behavior problems. With help at an early age, this could be avoided. Please contact me if you have any questions.
_____________________________ has my permission to be involved in the above checked small groups.
Please sign your name below:
_____________________________ Circle: Yes No
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_____________________________ has my permission to receive one on one counseling as needed. If you would like counseling to begin immediately, please indicate so at the bottom of this sheet.
Please sign your name below:
______________________________ Circle: Yes No
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