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Student | Parent
Consent Agreement

Complete the online Consent Agreement below and click Submit.

Consult Date
Month
Day
Year
Consult Time
Time
HoursMinutes

The student consultation/mentoring program is to help your child/young adult to grow and be able to have a

more productive lifestyle. This consent for is strictly for that purpose. FIAC is designed to protect the

parent and child from any lawsuits and legal matters in present day and future meetings

The parent must agree that the consultation/mentoring is strictly confidential and not designed to cause

harm to your child. The parent also understands that permission has been granted to your child to attend

seminars and events that will make a great impact on his/her life. The parent also understands that some

meetings will cause for parent involvement on some occasions.

A cancellation of a consultation should be made in 24 hours prior to the session.

Client shall not disseminate, publish, circulate, record, broadcast, videotape or transmit the meeting in any

form without the express written consent from FIAC. Client understands that this may involve an additional

agreement.

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Date
Month
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