Group Participation Consent Form

Dear Parents,

Addressing deficits in developing, maintaining, and understanding relationships is an important component of Applied Behavior Analysis. As such, StarBright ABA would like to look toward incorporating small group interactions amongst our kiddos. In order for us to integrate these opportunities into your child’s treatment we want to first get your permission. The information compiled will be used to group children accordingly.

Please read below and check all that apply.

Thank you.

I, First Name* Last Name* parent and/or guardian of First Name* Last Name* hereby grant permission for my child to participate in the following activities at StarBright Applied Behavior Analyst, PLLC.

Please check all that apply

Participate in small groups with other masked children.Participate in small groups with other unmasked childrenOpt out of small group participation.

Parent/Guardian Signature

Clear

StarBright staff will continue to follow all Centers for Disease Control (CDC) and New York State Health Department Covid 19 guidelines. Staff members will continue all COVID 19 cleaning protocols and wear proper PPE at all times.