Consent for Student and Family Services

LUMIN Schools

Concordia University School

Concordia University School-Pilgrim Campus

Northwest Lutheran School

St. Martini Lutheran School

Sherman Park Lutheran School

“Let the little children come to me, do not hinder them, for the kingdom of heaven belongs to such as these. He blessed them and went on from there”. –Matthew 19:14

An important component of the LUMIN Schools is to provide support services which include but are not limited to, group meetings, academic support sessions, peer mentoring and individual interventions; teachers, other faculty, and parents/guardians can recommend students for services. Generally, the purpose of these services is to manage minor social and/or behavioral concerns so that our children are able to grow academically, socially, and emotionally. Services may require a review of school records, classroom observations, consultations with school personnel, counseling, and referrals to community resources. Our hope and intention is to help all children grow to be what God intended them to be. If your child would benefit from services offered by the Department of Student and Family Services and the referral was made by a staff member you will be notified via phone, e-mail or mail. Our goal is to work with parents/guardians to assure successful outcomes for all. The information disclosed to Student and Family Service personnel is kept confidential. The only exception is when disclosure is required to maintain student safety or when required by law.

Please sign and date below, indicating your consent to allow Student and Family Services personnel to meet with your child(ren) throughout the 2014/2015 school year.

Blessings to You and Your Family,

Caroline Horn

Director of Student and Family Services

I understand and agree with the above informed consent information and give my permission for the Department of Student and Family Services personnel to meet with my

child(ren)______as needed throughout the 2014/2015 school year.

I am his/her/their legal guardian.

______

Signature of Legal GuardianDate