{"id":184,"date":"2023-01-19T13:37:34","date_gmt":"2023-01-19T03:07:34","guid":{"rendered":"https:\/\/applications.nazareth.catholic.edu.au\/student-forms\/?page_id=184"},"modified":"2023-03-02T16:36:12","modified_gmt":"2023-03-02T06:06:12","slug":"184-2","status":"publish","type":"page","link":"https:\/\/applications.nazareth.catholic.edu.au\/student-forms\/184-2\/","title":{"rendered":"Nazareth Years 7-12 Counselling Referral Form"},"content":{"rendered":"<script>\n\/\/----------------------------------------------------------\n\/\/------ JAVASCRIPT HOOK FUNCTIONS FOR GRAVITY FORMS -------\n\/\/----------------------------------------------------------\n\nif ( ! gform ) {\n\tdocument.addEventListener( 'gform_main_scripts_loaded', function() { gform.scriptsLoaded = true; } );\n\tdocument.addEventListener( 'gform\/theme\/scripts_loaded', function() { gform.themeScriptsLoaded = true; } );\n\twindow.addEventListener( 'DOMContentLoaded', function() { gform.domLoaded = true; } );\n\n\tvar gform = {\n\t\tdomLoaded: false,\n\t\tscriptsLoaded: false,\n\t\tthemeScriptsLoaded: false,\n\t\tisFormEditor: () => typeof InitializeEditor === 'function',\n\n\t\t\/**\n\t\t * @deprecated 2.9 the use of initializeOnLoaded in the form editor context is deprecated.\n\t\t * @remove-in 3.1 this function will not check for gform.isFormEditor().\n\t\t *\/\n\t\tcallIfLoaded: function ( fn ) {\n\t\t\tif ( gform.domLoaded && gform.scriptsLoaded && ( gform.themeScriptsLoaded || gform.isFormEditor() ) ) {\n\t\t\t\tif ( gform.isFormEditor() ) {\n\t\t\t\t\tconsole.warn( 'The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.' );\n\t\t\t\t}\n\t\t\t\tfn();\n\t\t\t\treturn true;\n\t\t\t}\n\t\t\treturn false;\n\t\t},\n\n\t\t\/**\n\t\t * Call a function when all scripts are loaded\n\t\t *\n\t\t * @param function fn the callback function to call when all scripts are loaded\n\t\t *\n\t\t * @returns void\n\t\t *\/\n\t\tinitializeOnLoaded: function( fn ) {\n\t\t\tif ( ! 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For urgent school related matters, please contact the College on 8406 5300.  For crisis support or urgent medical assistance, please call 000 or present at your local hospital.<\/label><input autocomplete=\"off\"  type='hidden' name='input_101.2' value='I understand that this is not an emergency service, and by proceeding I acknowledge that although the referral will be responded to within a timely manner, response times may vary.  For urgent school related matters, please contact the College on 8406 5300.  For crisis support or urgent medical assistance, please call 000 or present at your local hospital.' class='gform_hidden' \/><input autocomplete=\"off\"  type='hidden' name='input_101.3' value='24' class='gform_hidden' \/><\/div><\/li><li id=\"field_18_75\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Who is Referring<\/h2><\/li><li id=\"field_18_64\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_64'>Select<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_64' id='input_18_64' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' selected='selected'>Select<\/option><option value='Parent\/Caregiver' >Parent\/Caregiver<\/option><option value='Student (self referral)' >Student (self referral)<\/option><option value='Staff member' >Staff member<\/option><\/select><\/div><\/li><li id=\"field_18_76\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Your details<\/h2><\/li><li id=\"field_18_65\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_65'>First name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_65' id='input_18_65' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_72\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_72'>Last name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_72' id='input_18_72' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_99\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_99'>Year level<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_99' id='input_18_99' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' selected='selected'>Select<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><\/li><li id=\"field_18_100\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_100'>Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_100' id='input_18_100' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' selected='selected'>Select<\/option><option value='Male' >Male<\/option><option value='Female' >Female<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id=\"field_18_66\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_66'>Relationship to student<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_66' id='input_18_66' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_68\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_68'>Contact number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_68' id='input_18_68' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_39\" class=\"gfield gfield--type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_18_39_container'>\n                                <span id='input_18_39_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <input autocomplete=\"off\"  class='' type='email' name='input_39' id='input_18_39' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_18_39' class='gform-field-label gform-field-label--type-sub '>Enter Email<\/label>\n                                <\/span>\n                                <span id='input_18_39_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <input autocomplete=\"off\"  class='' type='email' name='input_39_2' id='input_18_39_2' value=''    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                                    <label for='input_18_39_2' class='gform-field-label gform-field-label--type-sub '>Confirm Email<\/label>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/li><li id=\"field_18_71\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_71'>MG Teacher<\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_71' id='input_18_71' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_69\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_69'>Is the student aware of the referral being made?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_69' id='input_18_69' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' selected='selected'>Select<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_18_70\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_70'>Does the Counsellor need to make contact with you prior to meeting with the student?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_70' id='input_18_70' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' selected='selected'>Select<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_18_74\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_74'>Have parents\/caregivers been made aware of this referral?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_74' id='input_18_74' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' selected='selected'>Select<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_18_92\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Student Details<\/h2><\/li><li id=\"field_18_93\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_93'>First name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_93' id='input_18_93' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_94\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_94'>Last name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_94' id='input_18_94' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_97\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_97'>Year level<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_97' id='input_18_97' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' selected='selected'>Select<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><\/li><li id=\"field_18_96\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_96'>Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_96' id='input_18_96' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' selected='selected'>Select<\/option><option value='Male' >Male<\/option><option value='Female' >Female<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id=\"field_18_95\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_95'>MG Teacher<\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_95' id='input_18_95' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_18_77\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Reason for Referral<\/h2><\/li><li id=\"field_18_103\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_103'>What is the reason for your referral?  Please describe the current situation and provide any relevant information.<\/label><div class='ginput_container ginput_container_textarea'><textarea autocomplete=\"off\"  name='input_103' id='input_18_103' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_104\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_104'>Why would you like to see someone from the Counselling Team? What is happening for you right now?  What would you like the Counselling Team to support you with?<\/label><div class='ginput_container ginput_container_textarea'><textarea autocomplete=\"off\"  name='input_104' id='input_18_104' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_79\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Background Information<\/h2><\/li><li id=\"field_18_80\" class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_80'>Please provide any background information that may help us support the student and understand their current situation.  I.e. family\/living arrangement, social, academic, strengths and\/or interests.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea autocomplete=\"off\"  name='input_80' id='input_18_80' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_105\" class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_105'>Tell us 3 things about you.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea autocomplete=\"off\"  name='input_105' id='input_18_105' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_81\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Additional Support<\/h2><\/li><li id=\"field_18_86\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_86'>Are you are aware of any external services, I.e.Psychologist, Psychiatrist, Counsellor, OT and Speech Pathologist, that the student is linked with?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_86' id='input_18_86' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' selected='selected'>Select<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><option value='Unknown' >Unknown<\/option><\/select><\/div><\/li><li id=\"field_18_87\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_87'>Please provide additional information if known<\/label><div class='ginput_container ginput_container_textarea'><textarea autocomplete=\"off\"  name='input_87' id='input_18_87' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_106\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_106'>Do you have any supports outside of school, I.e. Psychologist, Psychiatrist, Counsellor, OT and Speech Pathologist?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_106' id='input_18_106' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' selected='selected'>Select<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><option value='Unknown' >Unknown<\/option><\/select><\/div><\/li><li id=\"field_18_107\" class=\"gfield gfield--type-textarea gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_107'>Please provide additional information if known<\/label><div class='ginput_container ginput_container_textarea'><textarea autocomplete=\"off\"  name='input_107' id='input_18_107' class='textarea large'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_18_82\" class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_18_82'>As part of our Counselling Team, our Family and Pastoral Care Coordinator provides additional assistance to parents\/caregivers through practical support, advocacy and linking families with external services.  Would you like to make a referral to our Family and Pastoral Care Coordinator<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_82' id='input_18_82' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' selected='selected'>Select<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_18_108\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Nazareth Family and Pastoral Care Support<\/h2><div class='gsection_description' id='gfield_description_18_108'>Please complete this form to be contacted by our Family and Pastoral Care Coordinator. <a href=\"https:\/\/applications.nazareth.catholic.edu.au\/student-forms\/187-2\/\" target=\"new\" style=\"color:red; font-weight: bold;\">Click here (opens new tab)<\/a>.  <\/div><\/li><li id=\"field_18_73\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><h2 class=\"gsection_title\">Confidentiality<\/h2><div class='gsection_description' id='gfield_description_18_73'>Maintaining privacy and confidentiality standards are of the utmost importance to our counselling team.  For further information on our confidentiality requirements.\n\n<a href=\"https:\/\/www.nazareth.org.au\/__files\/d\/153454\/Confidentiality.pdf\" target=\"new\" style=\"color:red; font-weight: bold;\">Click here \n (opens new tab).<\/a><\/div><\/li><li id=\"field_18_35\" class=\"gfield gfield--type-consent gfield--type-choice gfield--width-full consent-form-text gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Acknowledgement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_consent'><input autocomplete=\"off\"  name='input_35.1' id='input_18_35_1' type='checkbox' value='1'  aria-describedby=\"gfield_consent_description_18_35\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_18_35_1' ><\/label><input autocomplete=\"off\"  type='hidden' name='input_35.2' value='' class='gform_hidden' \/><input autocomplete=\"off\"  type='hidden' name='input_35.3' value='24' class='gform_hidden' \/><\/div><div class='gfield_description gfield_consent_description' id='gfield_consent_description_18_35' tabindex='0'>I acknowledge that the information I have provided in this form will be received by the Nazareth Years 7-12 Counselling Team, and may be shared with relevant staff members (Leadership, MG Teachers, House Leaders etc) at the discrecion of the counsellors.  While all information provided within referrals and counselling sessions is treated in a respectful and sensitive manner, the sharing of information may at times be necessary in order to meet our duty of care.  For further information please <a href=\"https:\/\/www.nazareth.org.au\/__files\/d\/153454\/Confidentiality.pdf\" target=\"new\" style=\"color:red; font-weight: bold;\">click here (opens new tab)<\/a>.  Counselling staff will strive to respond to your referral as soon as possible.  Please note that referrals may not be received until the following working day and will not be monitored over weekends and school holiday periods.  For urgent school related matters, please contact the College on 8406 5300. 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