ORVIS RISNER Edmond Public Schools

ELEMENTARY SCHOOL 2801 S. Rankin St., Edmond OK, 73013

(405) 340-2984

Social Skills Small Group Consent Form

Dear Parents/Guardians,
Learning how to interact appropriately with others in a social setting is a lifelong skill. As part of our schools
Multi-Tiered System of Support, all students took part in a school-wide behavior screener to aid in addressing
the needs of students and teachers in the classroom. Because of this, your child is invited to to participate in
a social skills small group. The purpose of these groups is to strengthen students' self-esteem, promote
positive relationships, and encourage responsibility in an atmosphere of trust and acceptance. This involves
an opportunity for students to share, listen, and receive information about concerns they may have. These
groups will be facilitated by the two counselors at Orvis Risner.
Participation in the group is voluntary and involves parental consent. Groups will meet for six total times
during the school day. Meetings will be during non-essential instruction time, and will not interfere with
lunch/recess, specials or other school services. Our meeting format will include discussion and activities.
Students will be expected to respect the confidential nature of our discussion when they return to their
classes.
If your student is currently receiving outside counseling from a counseling agency please indicate that below
on the form. Unfortunately, for ethical reasons, students are unable to participate in school groups if they are
receiving outside counseling.
If you are interested in your child participating in a social skills group, please fill out the permission slip below
and return it to school as soon as possible. Feel free to contact us if you have questions or would like further
information about the groups.
Baylee Mielke, M.Ed. Jennifer Hess, M.Ed.
School Counselor School Counselor
baylee.mielke@edmondschools.net jennifer.hess@edmondschools.net

Childs Name _________________________________________________________ Teacher ________________________________________________________

_______ My child has permission to participate in a social skills small group at school.
_______ I do not wish for my child to participate in s social skills small group at school.
_______ My child receives outside counseling services.
How often? ___________________________________ Name of Agency _______________________________________

Parent signature ______________________________________________________________________ Date ____________________________________