Student Information Release Form

Student Information Release Form
I hereby authorise Barrington Training Services to disclose my personal information as stated in this Release Form to the Organisation/s stated below:
Name*

First NameLast Name
Email*
example@example.com
USI Number*
Course Name/Code Enrolled In*
Information to be Released:*

NameDate of BirthAddressEmailPhone NumberMobile Phone NumberEmergency Contact Name and Details
Other (Please specify):
(Specify information to be released if not listed)
I understand that my information is being released for the purposes of:*
(Provide brief explanation)
The organisation/s to which I give permission to receive my information from Barrington Training Services is/are:*
(Full name or organisation/s and contact information)
Signature*

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Date*

MonthDayYear
Date
Privacy Statement

The personal information supplied and collected in this Form is subject to the Privacy Act 1988 (Commonwealth) and will be treated in accordance with BTS’s Privacy Policy. A full copy of BTS’s Privacy Policy is available on our website.
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