Initial Assessment Form for Counselling

I confirm the information I have supplied is true and correct and understand it will be processed in line with the application terms and conditions. This is my application for an initial assessment with a trained counsellor with Yorkshire Children's Trust. If I provide details of a child, I agree to the services being provided and understand the counsellor will not divulge any information shared by the child.

Both the applicant and the parents and/or the legal guardian of the named child consent to the charity using the supplied information in line with GDPR and BACP regulations to store and use the data and provide the services of the charity.

I understand that this assessment is not a guarantee that counselling or play therapy service will be suitable for the child and the counsellor will make a professional determination if the services of the charity will meet the needs of the child. I understand that should the charity not able to provide immediate support, or if within sessions it is determined that the sessions no longer meet the need of the child (ie the child refuses to interact with the counsellor or if their needs can be more suited to another agency) that sessions may come to an end.

I understand that any information divulged to the charity during my initial assessment and future sessions will remain confidential and will not be shared with any outside agency unless there is a risk to life to myself or another person, it pertains to a criminal activity or an act of terrorism.