Citizens Commission on Human RightsNASHVILLE, TENNESSEE   615-784-8120

Watchdog Investigating & Exposing Psychiatric Human Rights Violations

Parental Consent Form


Follow these three simple steps to help safeguard your child. This form will let your schools know they must get your consent prior to any mental health screening or counseling.

The form is written to follow your child through progressive levels of school, however, we recommend submitting a new form each school year or whenever your child changes schools.

1

Download the form and print one for each of your children.
Click to download for:   Single Parent   Two Parents.

2

Fill it out and make at least 3 copies.

3

Deliver it to:

  • the Director of Schools (Superintendent) of your child’s school district*
  • your local school board*
  • the principal of your child’s school
  • Recommended: CCHR Nashville, PO Box 41795, Nashville TN 37204
  • Recommended: your attorney
  • Optional: other human rights and civil rights organizations
  • Optional: your child’s teachers

*If you are in Middle Tennessee, find your Director of Schools listed here. To write to your School Board, address your envelope to Board of Education and use the same address. Please contact us with any updates or additions.

County City Director of Schools Address City, State ZIP Phone
Cheatham Lynn Seifert 102 Elizabeth St. Ashland City, TN 37015 615-792-5664
Davidson Dr. Jesse Register 2601 Bransford Ave  Nashville, TN 37204  615-259-4636 
Dickson Charlie Daniel 817 N. Charlotte St. Dickson, TN 37055 615-446-7571
Maury Edward Hickman 501 West Eighth St. Columbia, TN 38401 931-388-8403
Montgomery Michael Harris 621 Gracey Ave. Clarksville, TN 37040 931-648-5600
Robertson Ronnie L. Meador 2121 Woodland St. Springfield, TN 37172 615-384-5588
Rutherford Murfreesboro Marilyn M. Mathis 2552 South Church St. Murfreesboro, TN 37127 615-893-2313
Rutherford not M’boro Harry Gill, Jr. 2240 Southpark Blvd. Murfreesboro, TN 37128 615-893-5812
Sumner Benny Bills 695 East Main St. Gallatin, TN 37066 615-451-5200
Williamson Franklin Dr. David L. Snowden 507 New Highway 96 W. Franklin, TN 37064 615-794-6624
Williamson not Franklin Rebecca Sharber 1320 West Main Franklin, TN 37064 615-472-4000
Wilson Lebanon Dr. Sharon Roberts 701 Coles Ferry Pike Lebanon, TN 37087 615-449-6060
Wilson not Lebanon James M. (Mike) Davis 351 Stumpy Lane Lebanon, TN 37090 615-444-3282




Notice: CCHR Nashville does not provide legal or medical advice. The information on this website is provided as a public service regarding laws and regulations that can be reviewed with an attorney or medical doctor so action can be taken as appropriate.

Victim of Brain Stimulation?

Do you know someone who has been damaged by experimental psychiatric treatments including transcranial magnetic stimulation (TMS), vagus nerve stimulation (VNS), deep brain stimulation (DBS) or any other electric shock or magnetic wave to the brain? Report abuse.

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CCHR Nashville is a qualified 501(c)(3) organization. All contributions are tax deductible to the fullest extent of the law.