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Wellbeing Support Referral & Consent Form

This form is to refer and give permission for your child to see our Wellbeing Support Officer, Erin Ireland, our Mental Health and Wellbeing Leader, Rhiannon Eustice or our Principal, Anthony Cross.

Once a referral has been made, we will review and allocate the case based on the level of need, and the capacity of our team. If you are concerned about any immediate risk of harm for this student, please come and speak with the Principal or teacher in charge immediately BEFORE the end of the school day so that intervention can occur.

Services that are offered:

  • supporting student attendance, engagement and mental health 
  • supporting students in difficult or challenging situations such as during times of grief
  • providing students with referrals to specialist services when required
  • providing care and guidance to students about values and ethical matters
  • supporting physical, emotional, social and intellectual development and wellbeing of students 
  • supporting an environment of cooperation and respecting a diversity of cultures and traditions.

Examples of relevant personal and health information that wellbeing staff may collect are:

  • medical information passed on by parents/caregivers
  • physical, mental psychological or other health information about you or your child
  • details about you or your child’s disability if applicable
  • expressed wishes about the future provision of health or wellbeing services, from you or your child
  • health or wellbeing services that have been or will be provided
  • any information necessary for the provision of services.

All information collected by Wellbeing Support will be stored confidentially and securely in hard copy and/or electronic formats.

This information may be used by staff at MSPS for the purposes of providing educational programs to, and making adjustments for, you or your child. The types of people who may be involved in discussions are; teachers, education support staff, other health professionals, or staff of an education and care service conducted through the school and attended by your child. 

You can access personal and health information held by the Department of Education about you and your child under the Freedom of Information Act 1982.

Key Areas of Concern (Select any that Apply)
Does the student have a diagnosis?
If known, what supports are already in place for the student? (Select any that apply)

I authorise and consent to the wellbeing support team to provide support services to my child. I confirm that:

I have received and read this Macarthur Street Primary School Wellbeing Support Consent Form.

I understand how my own and/or my child’s personal and health information will be collected, received, used, disclosed and managed.

I understand and acknowledge that the consent provided will continue whilst my child is enrolled in Macarthur Street Primary School unless I choose to withdraw it.