Parental Consent Form

Follow these three simple steps to help safeguard your child. This form will let your schools know they must get your consent prior to any mental health screening or counseling.

The form is written to follow your child through progressive levels of school, however, we recommend submitting a new form each school year or whenever your child changes schools.

1

Download the form and print one for each of your children.
Click to download for:   Single Parent   Two Parents.

2

Fill it out and make at least 3 copies.

3

Deliver it to:

• the Director of Schools (Superintendent) of your child’s school district^*
• your local school board^*
• the principal of your child’s school
• Recommended: your child’s teachers
• Recommended: CCHR Tennessee, PO Box 41795, Nashville TN 37204
• Recommended: your attorney
• Optional: other human rights and civil rights organizations

^*A current directory of Tennessee school superintendents may be found at this link.