CONSENT FOR SHARING OF CHILD AND FAMILY INFORMATION FOR CONTINUATION OF HEAD START SERVICES
Dear Head Start / Early Head Start Parents:
As indicated in our earlier communication, Childcare Resources has been appointed by the Office of Head Start to be a provider of Head Start / Early Head Start in our community. Childcare Resources became responsible for Head Start and/or Early Head Start services in the following zip codes effective July 1, 2020: 35022, 35094, 35203, 35205, 35206, 35217, and zip code 35212 shared with JCCEO in Jefferson County. We are asking for your assistance in making sure critical information about your child transfers from one agency to another if you would like to receive services from Childcare Resources.
In order to ensure that we protect the privacy of information in your child’s records, we are seeking your consent to transfer records to support the continuation of Head Start services.
To support uninterrupted services for you and your child and family, your child’s electronic and paper file at JCCEO Head Start/ Early Head Start will transfer to Childcare Resources as follows:
The entire child’s file, both in hard copy and electronic data to include, but not limited to:
1. Enrollment Information (application, eligibility determination)
2. Screening and Assessment Results and individual plans (Development Behavioral, Hearing, Vision, Health/Medical, Mental Health, Dental, IFSP, IEP, educational records)
3. Family Contact and Agreements
4. Transportation Services provided, if any
This form shall serve as an acknowledgment and agreement to the transfer of your child’s records.
JCCEO will release your child’s paper and electronic copies to Childcare Resources.
Thank you for your attention. We look forward to the successful continuation of services.