Be Heard Consent Form Child's Name * First Name Last Name Classroom Number Teacher's Name * Relationship to the child * My Name * First Name Last Name All Caregivers are aware of the Childs involvement? * Yes No If not, please let us know why I give consent for the Be Heard counsellor to speak to my child's teacher about my child's behavior at school * Yes No My child may attend the Be Heard Counseling service * Yes No Date * MM DD YYYY Thank you for filling in the consent form.
