As a custodial guardian of the student named, I hereby authorized the following credentialed social worker or therapist to meet with my child at Cottage Cove. I affirm that the following individual has my permission to speak one-on-one, unrecorded (if they so choose), with my child, recognizing that this is not normal procedure for the staff and volunteers of Cottage Cove. Furthermore, I hereby authorize this individual to speak with Cottage Cove staff in regards to behavioral, mental, and/or physical health issues regarding my child, including that they may share such confidential information with Cottage Cove staff as well.