Cool Kids Program Term 2 2023 — Bethel Christian School

Cool Kids Anxiety Program
Expression of Interest

Years 7-9 || Term 2, 2023

Student Name

First Name

Last Name

Date of Birth

YYYY

Year Group / Class

Parent / Guardian Name

First Name

Last Name

Phone

Parent / Guardian Email

What fears or worries does your child struggle with?

For example; very shy, worries about many different things, avoids particular places or situations, struggles to fall asleep, does not want to be away from parent.

What do you hope your child would be able to do after completing Cool Kids?

For example, confidently say hello to adults, stay at a friend's house overnight, able to complete school work without getting stressed.

Do you have other concerns regarding your child's emotions or behaviours?

For example, seems very sad a lot of the time, gets very angry, refuses to cooperate.

What additional support (at school or in the community) does your child receive?

For example, speech therapy, medication for ADHD.

Privacy / Confidentiality

We handle this information with privacy and confidentiality. This form submission will be sent directly to Anita Barber, School Social Worker.

Cool Kids Anxiety Program Expression of Interest

Years 7-9 || Term 2, 2023

Privacy / Confidentiality

Cool Kids Anxiety Program
Expression of Interest