Consent Form

Student Name*
Date Of Birth*
Date Format: MM slash DD slash YYYY
- EdSpace Education and Training center uses Wrap Around Kids Database , Owned and managed by Rodgers Medal Service's, to store relevant information for Students as required by Victorian regulations and Qualifications Authorities. At EdSpace this information is kept school records only.
- The purpose of the meeting is to increase understanding of my child’s specific strengths and areas of vulnerability so that support plans are based on student competencies.
- I understand my participation is voluntary, that I may withdraw at any time and that should I withdraw, all access to records created during our involvement will cease
- Any specific information collected will be confidential to myself/us, the Principal and the Wrap Around team. Copies of relevant reports may be shared with participants in the Wrap Around Meeting and other professionals, nominated by me/us on the attached Student Information Form.
- Reports of our meetings will be made available to relevant teacher(s) in order to assist them plan support for my/our child. A copy of the Wrap Around Meeting Report will be available for the parent
- carer/guardian and the student (if the student has signed an individual consent) approximately 24 hours before professionals. If no comments are received, the report will be made available to the authorised professionals.
Parent/Carer 1
Parent/Carer 2 (Optional)
Upload signature
Upload signature
Date
Date Format: MM slash DD slash YYYY
Date
Date Format: MM slash DD slash YYYY
Name
Name
Email
Email
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Phone

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