Parent/Carer Consent and Therapy Information Form - Corsham School

MUSIC THERAPY

PARENT/CARER INFORMATION AND CONSENT

Dear Parent/Carer,

Your child has been referred for music therapy by a member of staff at The Corsham School and is due to begin sessions shortly. This form provides information about the therapy process, includes a consent section, and offers you the opportunity to share anything that may help us better support your child.

What is Music Therapy?

Music therapy is a creative, arts-based form of psychotherapy that uses music, art, and conversation to support your child’s emotional and mental well being. Sessions are conducted on a one-to-one basis with a qualified therapist.

What happens in sessions?

Each session lasts 50 minutes and takes place in a private therapy studio at The Pound Arts Centre, a short walk from the school. Your child will work individually with a qualified music therapist—a registered healthcare professional—using creative expression to explore experiences, develop self-awareness, and support their overall wellbeing.

Are sessions confidential?

Yes. Sessions provide a confidential and safe space for your child to express themselves freely. However, if any safeguarding concerns arise, the therapist has a duty of care to share these immediately with Lydia Smith, Safeguarding Lead at The Corsham School.

How many sessions will my child receive?

An initial block of six weekly sessions will be offered. If further support is needed, therapy may be extended in additional six-week blocks, with the agreement of both the therapist and the pupil.

If you have any questions about the service, please don’t hesitate to contact me at will@therhythmpractice.org.

Yours sincerely,

Will Lawton, Music Therapist MA

Will Lawton is a professional member of the British Association of Music Therapy (BAMT) and the Health and Care Professions Council (HCPC). The Rhythm Practice are approved Alternative Providers (UKPRN 10094232) with Wiltshire Council and, as such, adhere to robust and comprehensive health and safety and safe guarding requirements.

Information about our procedures is available on request.

PLEASE COMPLETE THE FORM BELOW:

Details of parent/carer completing the form

First Name

Last Name

Telephone Number

Relationship with young person

Information regarding your child

First Name

Last Name

Date of birth

YYYY

Do you have any particular concerns about your child at the moment?

Please give any details of how you feel your child could benefit from therapeutic support?

Additional information

Please include any relevant history, such as self-harm, challenging behaviours, triggers, or other factors that may impact the young person’s engagement in music therapy.

Consent

Walking to sessions unaccompanied

I give permission for the above-named pupil to walk unaccompanied between Corsham School and The Pound Arts Centre (approx. 200m). They will sign in and out at the school reception before and after each session.

Yes

Recording

Video and/or audio recordings may be made during music therapy sessions for therapeutic purposes. These recordings will not be shared without pupil permission. I give consent for the therapist to make:

Audio Recordings

Video Recordings

Please submit this form by clicking on the button below.

All data is stored securely and confidentially in accordance with our data protection policy. A copy of your responses will be shared with Lydia Smith (safeguarding lead at Corsham School).