Forms & Consent

Educational service consent acknowledgment

A parent or legal guardian should complete this form for a minor. Adult learners may complete it for themselves. Please do not include diagnoses, medical records, or other sensitive health details.

Before you sign

This acknowledgment confirms consent to participate in virtual educational coaching or tutoring. It does not replace your enrollment or service agreement, and it is not consent for medical or mental-health treatment.

Questions? Contact info@positivekids.com or call 1-866-503-7454.

Complete the acknowledgment

Adult completing this form *

Email *

Learner name *

Relationship to learner *

Service *

Date *

Type your full legal name as your electronic signature *

By submitting, you confirm that the information is accurate and that your typed name is intended as your electronic acknowledgment.