The mission of the Family Connections’ School Based Youth Services Program, The Hub, is to empower Maplewood Middle School students to make responsible choices by providing services to enhance their social and emotional skills. These services include: Individual, Family, and Group Counseling, Recreation, Life Skills Training, Employment Training, Health and Prevention Education. Services are voluntary, funded by the Department of Children and Families (DCF) and managed by Family Connections so there are no costs to you or your child. In addition, services are provided confidentially. Please review the Notice of Privacy Practices sent home with this consent for the exceptions to confidentiality including a bi-annual evaluation and student registration in the DCF Management Information System. The purpose of this form is to gather necessary information and obtain approval for your child to participate in program services. This consent will remain in effect during the time your child is enrolled in Maplewood Middle School. With all forms of treatment, there are benefits as well as risks and you acknowledge that no guarantees have been made to you or your child as to the result of treatment and that compliance with treatment recommendations is necessary for maximum benefit. All counselors in Family Connections Programs meet the state requirement for licensure. I understand services may be provided by a graduate intern or a Licensed Master’s Level clinician who is under the clinical supervision of a fully licensed supervisor.