Parental & Learning Partner
Consent Form

This form grants permission for a child or learner to participate in one or more learning assessment activities facilitated by a CFV-trained church or community partner.

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Important: If the learner is under age 10, a parent, guardian, or learning partner should be present during the assessment to read questions aloud and assist with responses. These assessments are for educational guidance only and do not constitute medical, psychological, or clinical evaluations.

Section 1 — Facilitating Organization

Church / Organization Name

Facilitator Name

Facilitator Email

Facilitator Phone

Assessment Event Date

Section 2 — Parent / Guardian / Learning Partner

Parent / Guardian Full Name *

Relationship to Learner

Email Address *

Phone Number

Section 3 — Learner Information

Learner's Full Name *

Age *

Grade Level

Learning Environment

Section 4 — Assessments to Be Administered *

Select all assessments the learner will participate in during this session.

Section 5 — Consent & Agreements

Terms of Consent

By signing this form, I understand and agree that:

The selected assessment(s) are educational tools designed to identify learning preferences and cognitive strengths — they are not medical or psychological evaluations.
All responses are confidential and will only be shared with the facilitating organization and CFV staff for instructional purposes.
Results will be used solely to support the learner's educational development and will not be shared with third parties without my explicit consent.
Participation is voluntary and my child may discontinue at any time without consequence.
A parent, guardian, or learning partner will be present or available during the assessment if the learner is under age 10.
Cage Free Voices and the facilitating church organization are not liable for the interpretation or use of assessment results beyond their stated educational purpose.

I grant permission for the above-named learner to participate in the selected assessment(s) and understand the terms described above. *

I agree that assessment data will be stored securely by Cage Free Voices and used only for educational guidance purposes. *

I would like to receive a follow-up email with my child's learning profile and recommended next steps. (Optional)

Photo & Video Recording Authorization

Cage Free Voices and its authorized community facilitating partners may capture photographs, video recordings, and/or audio recordings during assessment events, workshops, and related program activities. The following options describe how such media may be used. Please select your authorization level.

Printed Name of Parent / Guardian *

Typing your full name constitutes a legal electronic signature.

Date *

* Complete all required fields and select at least one assessment to submit.

Educational Use Only: The assessments facilitated through this program are educational tools. They do not diagnose, treat, or evaluate medical or psychological conditions. All results are for instructional guidance only. © 2026 Cage Free Voices. All rights reserved.