Counselling Declaration Form Company Your Details Please insert the required information. First Name * Last Name * Email Address * Child’s Name (Full Name) * I, hereby declare that I am seeking free counselling for my son/daughter/ward for the sole purpose of improving his/her mental health and psychosocial wellbeing. I also confirm that I will not request information disclosed during the counselling sessions for the purpose of legal action in the form of child custody or other matters. I also fully understand that any attempt to involve ChildLine in such legal action will result in, but not limited to, an immediate termination of counselling service. * I have read, understand and is in agreement with this declaration.
