Parental Consent Form for Speech Therapy Services via Teletherapy School/Client Name*Student First Name*Student Last Name*Student Grade*Date* Date Format: MM slash DD slash YYYY I/we, parent/guardian(s) for the above named student, hereby grant permission to and authorize Hubbard & Tennyson to provide tele-therapy by means of an online learning platform chosen by Hubbard & Tennyson, in lieu of in-person speech therapy, to our child (listed above) until further notice due to the state wide closing of schools as a result of the COVID-19 Pandemic.Accept or Decline*AcceptDecline{Parent/Guardian(s) Sign Here}*(To sign this document enter your full name and press the "Sign" button.)Would you like to receive an email confirmation? Yes Email Address for Confirmation PhoneThis field is for validation purposes and should be left unchanged.
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