Section 5: Consent IMPORTANT: Please complete We would like your consent to contact any one of the agencies listed on the front sheet and refer on as appropriate. We may also want to contact other agencies that know you, such as your school or GP, to help us to provide a better service to you. We will ensure that your personal information is kept confidential, unless there are specific concerns that require us to share your details, in which case you will be told of this. 5(a) I agree to information being shared between agencies to help me / my child: Name of child / young person Signature Date Signature of principal parent / carer Date 5(b) If no consent, please state why: Version: 4.0 Date: 27/01/15 Author: Lucien Champion
Section 5: Consent IMPORTANT: Please complete We would like your consent to contact any one of the agencies listed on the front sheet and refer on as appropriate. We may also want to contact other agencies that know you, such as your school or GP, to help us to provide a better service to you. We will ensure that your personal information is kept confidential, unless there are specific concerns that require us to share your details, in which case you will be told of this. 5(a) I agree to information being shared between agencies to help me / my child: Name of child / young person Signature Date Signature of principal parent / carer Date 5(b) If no consent, please state why: Version: 4.0 Date: 27/01/15 Author: Lucien Champion