I agree to the release of only the information specifically outlined below. This release is valid for six-months or until ___________________ (fill in the date below). I further consent that unless otherwise stated, this release will stay in effect for employment and education verification until 1 year following program exit. I will sign a separate release if this information must be released to an organization/agency or persons other than the ones named below. I also consent to the agency’s use of remote communication for training and meeting purposes. I also consent to the agency’s use of remote communication for training and meeting purposes including the use of video technology. Please note this consent can be revoked at anytime by the client.