A school Speech Specialist shares a copy of the permission slip she uses below. Feel free to adapt it to your own needs if you wish:
Let me first introduce myself - I'm Lori Feinholz, Language and Speech Specialist at Castaic Middle School. I am having the pleasure of working with your son or daughter for speech therapy this semester.
During our therapy sessions, I have discussed with my speech students a possibility to utilize the Internet to find a penpal via a stuttering web site. The students seemed quite interested which prompted me to write to you. The students would be supervised on the Internet or I would type in their handwritten letters. In order to participate in this type of activity I need parent permission. I feel that middle school students are constantly exploring their feelings and attitudes and this is an avenue for them to hook up with other students who are like themselves in many ways.
I give my son or daughter, _____________________ permission to use the Internet at Castaic Middle School as part of our speech therapy program.
Thank you in advance,