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.
Fill it out and make at least 3 copies.
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.