TFFC Coaching Consent to Exchange Information Form

Tidewater Friends of Foster Care provides in-home coaching for youth that are interested in planning for their futures.

Coaching Consent to Release of Information

Students participating in the TFFC Coaching Program require a School Consent to Release student records on file with TFFC.

URL
This field is for validation purposes and should be left unchanged.
Name of Person Completing Coaching Information Consent*
First Last
NOTE: The Consent for Information Exchange must be signed by the Parent or Legal Guardian.
Organization
Email*
TFFC Coaching Program
TFFC provides one-on-one coaching to youth. Enrolled youth remain eligible for coaching through the end of the academic year. Parents/Guardians are responsible for providing a consent to release grades information, a suitable work environment, as well as materials and supplies. Parents/Guardians may request a change of coach if the relationship is not working for their student.
Youth Information
Youth's Name*
First Last
Date of Birth*
Month
Day
Year
Youth's Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
School*
Grade Level*
CONSENT TO EXCHANGE INFORMATION ON STUDENT
As the Parent/Legal Guardian, I understand that The Friends of Foster Care, Inc. (TFFC) provides services and benefits to my child. TFFC must have specific information to provide these services and benefits. By signing this form, I am allowing TFFC to exchange certain information so it will be easier for them to provide or coordinate these services or benefits. This consent will be provided to the school to allow exchange of information in support of coaching services.
Parent/Legal Guardian's Name*
First Last
Legal Guardian's Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
I want the following confidential information about the Student to be exchanged with The Friends of Foster Care, Inc. - 999 Waterside Dr., Suite 103, Norfolk, VA. 23510 Phone: 757-227-4187 Fax: 757-561-0979 Email: tutoring@friendsoffostercare.org*
- Select All
- Grades, Progress Reports and Report Cards
- Assessment Information
This information will be exchanged ONLY for the purpose of Service Coordination for the TFFC Career Coaching Program.
Period of Consent*
I can withdraw this consent at any time by notifying The Friends of Foster Care. This will stop all Schools/Agencies from sharing information after they know my consent has been withdrawn. I have the right to know what information about has been shared, and why, when, and with whom it was shared. If I ask, The Friends of Foster Care will show me this information.
Consent*
I agree to the above Exchange of Information.
Electronic Signature*
By selecting CONSENT box and Typing my Full Name above, I confirm my consent and understand that I am electronically signing this form.
Today's Date*
Month
Day
Year
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TFFC Coaching Consent to Exchange Information Form

Coaching Consent to Release of Information

TFFC Coaching Program

Youth Information

CONSENT TO EXCHANGE INFORMATION ON STUDENT

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