I hereby provide my consent to participate in transition coaching and/or employment-focused advocacy. I understand that this process may encompass assessment, consultation, court mitigation, and the sharing of personal information, which includes details regarding my occupation, court involvement, and criminal history, through live audio, video, or data communications.

Furthermore, I acknowledge that post-conviction employment advocacy may involve the communication of my behavioral health information, both orally and visually, to mental and medical practitioners located in Florida. I recognize my rights concerning court mitigation and/or advocacy:

1. I reserve the right to withhold or withdraw my consent at any time without affecting my entitlement to future coaching or treatment, nor will such withdrawal jeopardize any program benefits to which I may otherwise be entitled.

2. I consent to Impact Equitable Justice Inc. sharing my personal information with its partners within the criminal justice, behavioral health, and physical health care systems. I understand that the information disclosed during my rehabilitation or treatment is generally regarded as confidential.

I have thoroughly reviewed and comprehended this agreement, along with all the information contained within it. All my inquiries have been addressed to my satisfaction, and I hereby consent to the terms of this agreement. I do not hold Impact Equitable Justice Inc. or any of its partners liable for any risks or adverse consequences that I may encounter.