Form C - Advice for External Therapy Provision

FORM C - Advice for External Therapy Provision

Please complete this form to authorise provision of therapy during school hours for your child.

Therapy Details

Requested location for therapy/service during school hours

*If your child will be undertaking therapy during school hours which is not at Cloverdale ESC then they will require Alternative Attendance Arrangement approval (as per Section 24 of the School Education Act 1999). The school will contact you to make these arrangements.

Parent Acknowledgement

☐ Parent understands that principals may reconsider access for a provider at any time.
☐ Parent understands additional information about the decision making process is available on the Department of Education’s public website.
☐ Parent is responsible for communication with the provider including advising the provider if their child will be absent for the planned session
☐ Parent is responsible for communicating with the school to advise on any changes to provider, absence of provider or absence of their child.
☐ Parent understands the school will not cover any costs associated with the provider’s access to the student at school.
☐ Parent gives consent for the release and exchange of information between the provider and the school.

Write your signature above the line

180 Fisher Street
Cloverdale WA 6105

Phone: 08 9438 7850