Consent for Virtual Non-Mandated
Counseling Teletherapy Services

Due to the current COVID-19 Pandemic, the Comsewogue School District will be providing virtual non-mandated counseling services delivered by our School Psychologists, Certified Social Workers, or Guidance Counselor.  Our counselors are committed to providing your son/daughter with the additional support they may need during this unprecedented health situation.

This means that we will be able to provide non-mandated counseling services through digital meetings/sessions via the Google Classroom/Meet format.  The counselor and the student will join a computer based session at a designated time.

to engage in non-mandated counseling services via teletherapy as delivered by my child’s psychologist, social worker, or school guidance counselor. I understand that teletherapy includes treatment using interactive audio, video, or data communications.
 

I understand with respect to virtual non-mandated counseling that I have the right to withhold or withdraw my consent at any time without affecting future sessions.

I understand that I am responsible for:

(1) ensuring access to the necessary computer, telecommunications equipment and internet access for the teletherapy sessions

(2) the information security on my computer

(3) arranging a location with sufficient lighting and privacy that is free from distractions for my child’s virtual counseling session.

We ask all students and family members to be respectful of the privacy interests of other students. As a result, where possible, students participating in group services should attempt to do so from a location which can not be observed by others and utilize headsets.  To the extent that family members observe the delivery of instruction of other students, we ask that you respect the privacy of the other students and not disclose personal information about any student to any third party.

Please note: At this time, your son/daughter may not be participating virtually, however your signature below will indicate your consent for virtual counseling services, in the event that the school district moves to an all “on-line” format due to a COVID-19 school closure. 

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Parent/Guardian Signature *
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