Positive Kids consent form

Executive Functioning Coaching Services Consent Form

Complete this secure online consent form before your child's executive functioning coaching services begin. The form confirms parent or guardian permission, communication preferences, and acknowledgement of service limits.

Purpose of executive functioning coaching

Positive Kids provides executive functioning coaching to support children and youth with skills such as organization, planning, time management, focus, task initiation, emotional regulation, problem solving, and follow through.

Executive functioning coaching is not therapy, counselling, psychological assessment, or a medical service. Coaches do not diagnose mental health, learning, or developmental conditions. The goal of coaching is to help the child or youth build practical strategies that can be used at home, school, and in daily life.

Goals coaching may support

Improving organization and planning
Building routines and structure
Completing homework or school tasks
Managing time more effectively
Developing focus and attention strategies
Improving emotional regulation and frustration tolerance
Building independence and confidence
Supporting follow through with daily responsibilities

Child or youth information Child/Youth Name * Date of Birth * Start Date

Parent or guardian information Parent/Guardian Name * Phone Number * Email Address *

Parent/guardian consent I give permission for my child to participate in executive functioning coaching services with Positive Kids. I understand that parent or guardian involvement may be recommended to support progress, including updates, suggested strategies, home routines, or communication about goals and challenges. I understand Positive Kids will respect privacy and keep information confidential except when disclosure is required by law or necessary for safety.

Communication with others

Positive Kids will not communicate with schools, doctors, therapists, or other professionals without parent or guardian consent, unless required by law or needed for safety.

If needed, I give permission for Positive Kids to communicate with the individual or organization listed below. Name/Organization Purpose of Communication Parent/Guardian Initials

Attendance, cancellations, and limits of service I understand that consistent attendance is important for progress and agree to follow Positive Kids' cancellation, rescheduling, and payment policies as provided to me. I understand executive functioning coaching does not guarantee specific academic, behavioural, or emotional outcomes. Progress depends on attendance, family support, motivation, consistency, and the child's individual needs.

Signature Parent/Guardian Typed Signature * Date * Positive Kids Representative