Talk Time - Harmony Public Schools

Talk Time Request Form

During Talk Time a parent/guardian should be at home, we will need the contact number for the person that will be at home during this time. This Talk Time will occur via a Zoom meeting. Students will need internet connection and should have a quiet and private area. Please note that due to demand it may take a counselor 1 business day to respond to this form. This forum is not set up for emergency situations, if you have a medical or mental health emergency please call 911. Permission for Talk Time can only be granted by a parent/guardian. If you have an urgent mental health need related to the stress of COVID-19, please call the COVID-19 hotline at 833-986-1919.

If your child attends school in HOUSTON NORTH District, please visit their campus website and look for the SAF (Student Assistance Form) link or QR code.

Your Consent (required)

I have read the expectations detailed above and agree to the terms.

Yes

No - you must accept terms for counseling to occur

I understand that by completing this form I am giving consent for my child to receive virtual Talk Time services. Following this submission I will be contacted by telephone to verify this consent before Talk Time will occur. Please print full name,**

Please select the campus **

Parent/Guardian Information

Name **

Phone Number**

Parent Email (optional)

About Student

Student Name **

Grade (optional)

Best time frame to contact to schedule Talk Time?

Does student currently see a counselor at your campus?

Yes

What are your child's Talk Time needs? If this is a medical emergency please call 911 or if you need to speak to someone immediately please call the COVID-19 mental health hotline toll free at 833-986-1919.

Talk Time Request Form

Your Consent (required)

Parent/Guardian Information

About Student

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