Parent Consent Form

Parent Assent Form

RAJO Group and Evaluation - Parent Consent

Form RP-102:

Youth/Participant Information:

First Name

Last Name

Phone Number

Email Address

Gender

Male

Female

Birth Date

Parent/Guardian Information:

Parent/Guardian Name

Last Name

School

Grade

Relationship To Youth/Participant

Email Address

Phone Number

Resident Address

City

Postal Code

By signing this form, you agree that you are fully informed about the goals of the RAJO program and evaluation and understand what your and/or your child's participation involves. If you change our mind later, just let any RAJO staff or school principal know.

Group Sessions AND Evaluation

I consent to allow my child, to participate in the RAJO group sessions and evaluation which may involve being contacted at a later date by RAJO staff

RAJO Group Sessions Only

I consent to allow my child to participate in the RAJO group sessions only

Access To School Data

I agree that RAJO counsellors can access my school administrative data (such as report cards and information about my grades, attendance, and/or disciplinary incidents) with SRDC for use in the evaluation

Sharing De-Identified School Data

I agree that RAJO can share my de-identified school administrative data (such as report cards, and information about my grades, attendance, and/or disciplinary incidents) in accordance with local school/school board processes

RAJO Evaluation

I agree to participate in the RAJO evaluation

Parent/Guardian Signature

Date

Cookie	Duration	Description
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