Purpose: As required by SB 12, we are requesting your annual consent for your child to receive routine school-based health and counseling services from qualified school staff, including nurses, athletic trainers, and counselors. This consent supports timely and equitable access to care that promotes student safety, wellness, and readiness to learn. Consent is valid for the entire school year unless you choose to revoke it in writing.
For the 2025-2026 school year, parents/guardians should complete the Routine Health Services and Counseling Consent Form as soon as possible, but no later than September 17, 2025.
**If this form is not completed by September 17, 2025, school staff will be unable to provide your child with routine physical or mental health services, such as basic first aid, over-the-counter medications, or wellness checks, unless the care is required to provide life-saving care to a child in an emergency.
If any health services are needed beyond the routine services included on the Routine Health Services Consent Form, campus staff will contact the parent to discuss their child’s additional needs and seek further consent for non-routine health services recommended.**
Examples of Routine Services That May Be Provided, but are not Limited to:
Health-Related Services (by school nurses or athletic trainers):
- First aid and injury evaluation
- Administration of over-the-counter medications per school policy
- Monitoring of chronic health conditions (e.g., asthma, diabetes)
- Vision, hearing, Acanthosis Nigricans, and Scoliosis screenings
- Support during illness or physical symptoms at school
- Heat illness prevention and injury support for student athletes
Counseling Services (by school counselors):
- Short-term individual counseling or check-ins
- Comprehensive student-success needs assessment (academic related behavior needs like study skills and school involvement, not for mental health diagnostic purposes)
- Social-emotional skill-building or group counseling
- Support during emotional distress or crisis, including assessment following a reported concern of student self-harm or harm to others
- Behavioral observations and problem-solving
Referral to external providers, if needed (with additional consent)
What This Consent Does Not Include:
- Formal medical or psychological diagnosis
- Prescription medication administration without proper authorization
- Ongoing therapy or treatment requiring parental notification under the law
These activities would require separate written consent and parental involvement.
To complete the consent form in Ascender:
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