Page 97 - Meeting with Children Manual

P a g e | 3 Child and Youth Meeting

File Number ________________________

CHILD ASSENT

FORM

DATE_________________ CHILD’S NAME____________________________

AGE_____ CHILD’S DATE OF BIRTH ___________________

SCHOOL ATTENDED: _________________________________________ GRADE ________

PARENTS_______________________________________

WHY AM I MEETING WITH YOU?
Your mom and dad said that they would like you to be able to share what you
would like with someone who could help them make things even better for
you. Your parents think you are a very important person in the family and they
think your ideas are important too.

WHAT WILL I DO WHEN I AM WITH YOU?

I have some activities that could be fun for you to try. Some things are about
art-making and other things are about picture cards, stories and play. I don’t
just “talk” to kids because that could be a bit boring… I have some play
activities that other kids find fun to do.

WHAT IF YOU DON’T WANT TO DO SOMETHING I ASK YOU TO TRY?

If you don’t like the ideas I have, then you don’t have to try them. You can
decide.

WHAT WILL YOU DO WITH THE THINGS I TELL YOU?

Some kids share things that they would like me to tell their parents. Other kids
do drawings that they would like me to share with their parents. Sometimes they
want me to take pictures of their art to show their parents. Other times kids
decide they don’t want me to share because they feel they will hurt their
parent’s feelings. Some kids don’t mind if I share everything.

© Lorri Yasenik and Jon Graham 2016
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PAGE 95