Boys and Girls Club Community Consent Form – Supporting Kidds

Dear Boys and Girls Club Families,

Hello! I am Katie Koontz, the Clinical Director for Schools and Community Engagement at Supporting Kidds. Supporting Kidds is a non-profit organization located in Hockessin, DE that provides grief support to children ages 5-18 and their families.

Supporting Kidds recently started a community partnership with the Boys and Girls Club and will offer a few opportunities for your children to learn more about themselves, their feelings, and effective coping skills.

Supporting Kidds will offer three activities for your children to participate in and learn helpful lifelong skills. We will send trained facilitators to run the sessions, each of about 30 minutes. Children will be placed in age-appropriate groups and will receive a snack every session. We also provide all materials to complete the activities.

Activities/ themes for the three sessions are:

Heart Map- Children will identify different things that make their heart feel full and things that make them feel happy. It is helpful for personal growth to know what makes you feel happy and to keep them close.

Feelings Thumbprints- Children will name feelings through games and complete their own Feelings Thumbprint board which increases feelings identification.

Coping Skills Toolbox- Children will build their own Coping Skills toolbox and explore effective ways to handle stressful situations.

Mariposa Arts- An art for wellness organization that we have partnered with will provide a fun art session at The Boys and Girls Club for the children who participated in our program.

Consent Form:

Below please find the consent form to allow your child/children to participate in the three-week activities. Please cut on the dotted line and send it back to the Boys and Girls Club by Wednesday October 20th, 2023. We will provide these three activities and then determine if we will be back in the Fall to provide Healing Pathways, our six-week bereavement support group. This will be for children who could benefit from additional support due to the loss of a loved one.

Feel free to check out our website: www.SupportingKidds.org for additional information about us.

Kathleen D. Koontz LPCMH, NCC, GC-C Email: Kathleen.Koontz@SupportingKidds.org

Child Name

First

Last

Child Grade

Please select one:

I DO give my permission for my child to participate in the Supporting Kidds program and I allow photos of my child and/or their artwork to be utilized by Supporting Kidds Staff for funders and awareness of the program.
I DO NOT give permission for my child to participate in the Supporting Kidds program.

Parent/Guardian Signature

Clear Signature