I, _______________________________________, understand that anything I say
during meetings with the school counselor is confidential; however, if by my
words or behavior, the counselor believes I could be a danger to myself or to
others, he/she is obligated to report to parents, authorities and/or other
responsible parties. I also understand that the counselor is required to report any
and all reports of abuse or suspicions regarding abuse. Specially, I understand
that information shared for assessment may be shared with the Department of
Health and Human Resources/Department of Juvenile Services, and may be
shared with social workers, probation officers, judges, other court officials, local
education agencies or colleges.
________________________________________
Student Signature
_______________
Date
________________________________________
Counselor Signature
_______________
Date