Effective Date: 02/2023
Processed Date: ________
ChildCareEd Release of Information Form
Upon submission of a completed ChildCareEd Release of Information Form, from the applicant by signature only, records will be released and forwarded within a period of 7 to 14 business days, based on need. Expedited records may be requested for an additional fee.
I ____________________________, give permission for H&H Child Care Training Center, LLC (DBA ChildCareEd) to share and exchange information with other staff at __________________________ for the purpose of providing assistance to me. ______ (initial)
I, ______________________________, give permission to H&H Child Care Training Center, LLC (DBA ChildCareEd) to share information with the following service agencies for the purpose of providing assistance to me. ______ (initial)
List names of agencies below:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
I confirm that I have reviewed the ChildCareEd POLICY ON RECORDS, RELEASE, AND PRIVACY on the website www.ChildCareEd.com and I understand its content. My signature below indicates my consent.
Signature _______________________________________________ Date ___________________
