In order to provide the best services possible, ACCOUNT_JOB_COMPANY (”Client”) may need to to share personal information about you, and/or your child, to one of our trusted partners. The information may be educational, medical, psychological, psychiatric, social and/or psychometric in nature. No matter the kind of information, we will always ask your consent first, and only ask for information that is necessary. With the assistance of a Client staff member, please fill out the following information.
I, AUTHORIZER hereby authorize ACCOUNT_JOB_COMPANY to release/exchange information regarding myself and/or my child as follows:
| Information Released | INFO |
| Purpose | PURPOSE |
| Partner Agency | PARTNER_AGENCY |
| Address | ADDRESS |
| Phone | CONTACT_NUMBER |
Signatures:
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