ITTS For Children
Individual and Team Therapy Services
COMMUNICATION RELEASE
I hereby grant ITTS For Children permission to contact the individuals/agencies listed below on behalf of the Client Name listed:
*
Client Name
*
First Name
Last Name
Signature of Client or Parent/Guardian if below 18
*
Parent/Guardian Name
First Name
Last Name
Email:
*
example@example.com
Date
*
-
Month
-
Day
Year
Save
Submit
Should be Empty: