Water Valley ISD

🐾 Wildcat Nation‼

Notice of and Consent for School Health-Related & Counseling Services Form

✅ All Water Valley ISD students must have this form signed by a parent/guardian in order to be seen by our District Nurse or School Counselor.

This form must be signed and returned to WVISD District Nurse, Tallyn Holt, RN, BSN and WVISD Counselor, Christina Colwell. The Google Form will allow your response to go to both our school nurse and counselor.

Consent given through this form is effective during the current school year unless revoked earlier.

In accordance with law, the District must provide parents with written notice of each school-based health-related and counseling service offered at the campus their child attends. These routine services promote student safety, wellness, mental health, and readiness to learn. The services may be provided by qualified school staff, including nurses, CNAs, athletic trainers, and counselors.

⚠ Please note: This consent does not take the place of an individualized health plan, 504 plan, or any other legally required document.

This form can also be found on our website, www.wvisd.net, under " Menu " and under the " For Parents " Section

Thank you for taking time to complete and return this important form as soon as possible.

Form: https://forms.gle/pn3AT7MdKUYQqJWv6
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