JSSA Mindcraft Parent Forms

Below please find the forms parents will need to complete in order for your child to participate in the Mind Craft Program. All three forms must be completed for a referral to be accepted.

If you have any questions or concerns, please contact Andrea Hamer at 301-610-8367.

Forms for Parents to Fill Out Online

JSSA Acknowledgements and Consent Forms

MCPS Authorization for Release/Exchange of Confidential Information

 

Forms for Parents Referred to Wraparound Montgomery

Consent to Release Information (Wraparound Montgomery ONLY)

Consentimiento para liberar información (Wraparound Montgomery ONLY)

 

Forms for Parents to Review and Print for Records 

Fee Agreement Schedule

Client Consent and Acknowledgements and Complaint and Grievance Procedure

Notice of Privacy Practices

SPANISH- Fee Agreement and Schedule

SPANISH- Client Consent and Acknowledgements and Complaint and Grievance Procedure

SPANISH- Notice of Privacy Practices