"Permission to Release Information" - Nevada

This Nevada-specific "Permission To Release Information" is a document released by the Nevada Department of Health and Human Services.

Download the fillable PDF by clicking the link below and use it according to the applicable legal guidelines.

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Download "Permission to Release Information" - Nevada

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PERMISSION TO RELEASE INFORMATION
Date:
I understand that the time my child,
is in the facility, that the director may be asked for information regarding my child.
I hereby give permission to release information to official persons only, who identify themselves, such
as schools, health care personnel, welfare or other governmental officials.
Signature of Parent/Guardian
Date
**********************************************************************************************************************
I do not give permission to release information about my child as set forth in the aforementioned
statement. I realize that Child Care Licensing has access to my child's record as the licensing agent.
Signature of Parent/Guardian
Date
PERMISSION TO RELEASE INFORMATION
Date:
I understand that the time my child,
is in the facility, that the director may be asked for information regarding my child.
I hereby give permission to release information to official persons only, who identify themselves, such
as schools, health care personnel, welfare or other governmental officials.
Signature of Parent/Guardian
Date
**********************************************************************************************************************
I do not give permission to release information about my child as set forth in the aforementioned
statement. I realize that Child Care Licensing has access to my child's record as the licensing agent.
Signature of Parent/Guardian
Date
PERMISSION TO RELEASE INFORMATION
Date:
I understand that the time my child,
is in the facility, that the director may be asked for information regarding my child.
I hereby give permission to release information to official persons only, who identify themselves, such
as schools, health care personnel, welfare or other governmental officials.
Signature of Parent/Guardian
Date
**********************************************************************************************************************
I do not give permission to release information about my child as set forth in the aforementioned
statement. I realize that Child Care Licensing has access to my child's record as the licensing agent.
Signature of Parent/Guardian
Date
PERMISSION TO RELEASE INFORMATION
Date:
I understand that the time my child,
is in the facility, that the director may be asked for information regarding my child.
I hereby give permission to release information to official persons only, who identify themselves, such
as schools, health care personnel, welfare or other governmental officials.
Signature of Parent/Guardian
Date
**********************************************************************************************************************
I do not give permission to release information about my child as set forth in the aforementioned
statement. I realize that Child Care Licensing has access to my child's record as the licensing agent.
Signature of Parent/Guardian
Date
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