[PDF]Parental-Guardian Consent Form - Rackcdn.comhttps://1c0130325dca084aa0d4-4892c4c22fe31d1ed215e2fb5341fe81.ssl.cf2.rackcd...
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PARENTAL/GUARDIAN CONSENT Name of Child/Children
1.
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2.
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3.
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4.
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I/We am/are the parent(s) or otherwise the legal guardian(s) for the above listed child(ren). I/We agree to take total responsibility for the results of the counseling session and hold free and harmless from any and all liability both the counselor and Sagemont Counseling Center.
I/We have read and understand the above paragraph and give my/our consent to my/our child(ren) participating in counseling sessions at the Sagemont Counseling Center.
Signature: ____________________________________
Date: ______________________
Signature: ____________________________________
Date: ______________________