Parental Consent Form

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The University of South Wales operate a counselling service on behalf of Newport City Council within your child’s school.

Appointments will be confidential unless it becomes apparent that your child or someone else is at risk of significant harm. In this case, assurance will be given to your child that the best decisions will be made regarding their safety or the safety of others. If your child needs additional help and support this will be discussed throughout the sessions and the involvement of parents will be encouraged to arrive at the best options to suit the child’s individual need. All counselling sessions are conducted in private rooms solely between your child and the counsellor. To ensure best practice is adhered to, counsellors receive clinical supervision and line management. All counsellors go through an annual enhanced check by the UK Government Disclosure and Barring Service.

Please read our Privacy Notice

Mae’r ffurflen hon ar gael yn Gymraeg. This form is available in Welsh.

1.1. Child's First Name & Surname

a.1.a. Child's Date of Birth

(dd/mm/yyyy)

2.2. Please provide the name of your child's school Required

3.3. Your Name

4.4. Your email address

5.5. Your telephone number

6.6. Date consent given

(dd/mm/yyyy)

7.7. As the parent (or legal guardian), I have read and understood the Parent Consent Information & Privacy Notice and I agree to my child receiving counselling.

Yes