Pathways

The mission of Pathways is to address all the needs of the students of Carteret High School
so that when they are in the classroom, they can focus on learning
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  5. Pathways Program Consent for Services

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Pathways Program Consent for Services

Please complete this form and submit it. This will get copied to our administrators of the program and you will get a chance to print the form to sign and bring an original for our records.

Items marked * are requied

Student Details
Contact Details
Consent

I consent to have my son or daughter receive services provided by PATHWAYS, Carteret’s School-based Youth Services Program, including those provided by the Nurse Practitioner, with the exception of the specific services I have noted below (if any).

I understand that clinical documents are confidential and may only be released with consent or at the professional discretion of the SBYSP employee. I further understand I will be contacted if my child needs medical attention beyond what can be provided on site by the Nurse Practitioner.

After you have completed this form you will be given a chance to download it as a PDF. This will let you print it so you can sign it and return it to us.

Pathways Programs Menu