7/26/2019 Recording Consent Form

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DRAKE UNIVERSITY

Counseling Program

Consent to Interview and Record

The Counseling Program at Drake University requires Counseling Practicum Students to recordcounseling sessions with students/clients/consumers for the purpose of evaluating and

improving their counseling skills. ll recordings will !e kept confidential. The recordings will !e

viewed !y the Counseling Practicum Student"s supervisor and parts of some sessions may !e

shared with other Counseling Practicum Students for the purpose of providing feed!ack.

#ecordings of session are made for educational and training purposes for Counseling Practicum

Students. The recordings are in no way part of any records at the school or agency where you

or your child is a student/client/consumer. t the end of each academic term all recordings will

!e destroyed.

$ give permission for %mily &ames to record counseling sessions with my student/child for

training purposes. $ understand that recordings will !e kept confidential and that they will !e

destroyed at the end of the academic term '(ay of )*+,-. $ also understand that $ can choose to

withdraw my student from these sessions at any time.

Print ame Student/Client/Consumer

Print ame Parent or 0uardian if Student/Client/Consumer is under +1

Signature Parent or 0uardian Date

Signature of Counseling Practicum Student Date