Please review the consent information for Positive Kids executive functioning coaching services. This page explains the purpose of coaching, parent/guardian consent, confidentiality, communication permissions, attendance expectations, limits of service, and signature details.
Positive Kids Consent Form
Service: Executive Functioning Coaching Services
Client and Parent/Guardian Information
- Child/Youth Name
- Date of Birth
- Parent/Guardian Name
- Phone Number
- Email Address
- Start Date
Purpose of Executive Functioning Coaching
Positive Kids provides executive functioning coaching to support children and youth with practical skills such as organization, planning, time management, focus, task initiation, emotional regulation, problem solving, and follow through.
Executive functioning coaching is not therapy, counselling, psychological assessment, or a medical service. Coaches do not diagnose mental health, learning, or developmental conditions. The goal of coaching is to help the child or youth build practical strategies that can be used at home, school, and in daily life.
Parent/Guardian Consent
By giving consent, the parent or guardian gives permission for their child to participate in executive functioning coaching services with Positive Kids.
The coach may work with the child or youth on goals such as:
- Improving organization and planning
- Building routines and structure
- Completing homework or school tasks
- Managing time more effectively
- Developing focus and attention strategies
- Improving emotional regulation and frustration tolerance
- Building independence and confidence
- Supporting follow through with daily responsibilities
Parent/Guardian Involvement
Parent or guardian involvement may be recommended to support progress. This may include updates, suggested strategies, home routines, or communication about goals and challenges.
Coaching works best when strategies are practiced outside of sessions and supported consistently by the family.
Confidentiality
Positive Kids will respect the privacy of the child and family. Information shared during services will be kept confidential, except when disclosure is required by law or necessary for safety.
Confidentiality may be broken if there is concern about:
- Risk of harm to self or others
- Abuse or neglect of a child
- A legal requirement to release information
- A serious safety concern requiring parent, guardian, or emergency involvement
Communication With Others
Positive Kids will not communicate with schools, doctors, therapists, or other professionals without parent or guardian consent, unless required by law or needed for safety.
If communication with another individual or organization is needed, the form may include the name or organization, the purpose of communication, and parent/guardian initials.
Attendance and Cancellations
Consistent attendance is important for progress. Families agree to follow Positive Kids’ cancellation, rescheduling, and payment policies as provided.
Limits of Service
Executive functioning coaching does not guarantee specific academic, behavioural, or emotional outcomes. Progress depends on several factors, including attendance, family support, motivation, consistency, and the child’s individual needs.
Consent and Signature
By signing the consent form, the parent or guardian confirms that they understand the nature of executive functioning coaching services and gives permission for their child to participate.
- Parent/Guardian Name
- Parent/Guardian Signature
- Date
- Positive Kids Representative
- Positive Kids Representative Signature
- Date