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Consent for Virtual Speech/Language
Teletherapy Services

Dear Parent/Guardian,

Due to the current Covid-19 Pandemic, the Comsewogue School District’s Speech/Language Therapy Department may at times have to provide virtual speech services for students throughout the course of the year.  Our Speech Teachers 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 speech therapy services through digital meetings/sessions via the Google Classroom/Meet format.  In the event that it becomes necessary, the speech teacher and the student would join a computer based session at a designated therapy time and would work on established goals, just as would take place within the school setting.  This mode of service delivery, when implemented correctly, is noted to have equal outcomes to face-to-face interventions.

to engage in Speech and Language teletherapy as delivered by my child’s Speech Teacher.  I understand that teletherapy includes treatment using interactive audio, video, or data communications.

I understand with respect to Virtual Speech Therapy that I have the right to withhold or withdraw my consent at any time without affecting future care or treatment.

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 speech therapy 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 speech services, in the event that at a future time, your son/daughter might be in need of this service.

Parent/Guardian Signature *