Word Bird Program – Parent/Guardian Consent Form

Pelican Talk Speech Therapy Resources ABN 87 985 918 338

About the Project

The Word Bird Program is a program developed by speech pathologist, Lucia Smith (Pelican Talk).
It aims to help get children “ready” for learning to read and write when they head off to school.

It does this through a fun session run at preschool during mat time using a chicken puppet who lays words! Together, children learn to think and talk about words, letters and sounds in a playful manner.

This pilot project will begin with the 4-year-old group at Orbost Kindergarten and may later extend to other kindergartens.

You can watch a video clip on Youtube about the Word Bird session so you can understand how to support your child in their learning. The link to this will be emailed to you or sent to your phone after you have filled out the consent form.

What Participation Involves

  • 10 – 15 minute group sessions led by Lucia Smith, a qualified speech pathologist. These will run 1-2 times a week from the end of October to the first week of December 2025.
  • Pre- and post-program screenings to observe progress in early language and literacy skills.
  • Engaging, evidence-based activities designed to make learning fun and meaningful.
  • Sessions will take place during normal kindergarten hours and will not interfere with other activities.
  • Participation is voluntary, and families may withdraw consent at any time.
  • Photographs or short video footage may be taken during Word Bird sessions to help illustrate the program in action. Your child’s face will not be shown in any displays, publications, or presentations unless you provide consent after the program has been completed.

Privacy and Data Use

  • Your child’s name or identifying details will never be used publicly.
  • Group-level data (with no names attached) may be used to evaluate or improve the Word Bird program.
  • You may be contacted after the session regarding use of your child’s face in any photos or video-clips. Without your consent, these images will NOT be used.

Contact

Please contact Lucia with ANY questions at ANY time before, during or after the program starts.

Contact: Lucia Smith

Email: [email protected]

Word Bird Program Consent

This field is for validation purposes and should be left unchanged.
Child's Name(Required)
DD slash MM slash YYYY
Parent/Guardian Name(Required)
DD slash MM slash YYYY
Consent Statement – Participation in the Screening and Program(Required)
I understand what participation in the Word Bird program involves. I understand that my child’s involvement is voluntary and that I can withdraw consent at any time without consequence. I understand that filming and photographs may be taken during the program but my child’s image will not be used in any publications or training sessions until I have viewed the images or footage and given consent. I freely and voluntarily give my consent for my child to participate in the program described.