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DWI Intervention Consent for Release
Brian Knaack
2022-08-29T09:56:10-05:00
DWI Intervention Consent for Release
Complete this form prior to the first day of the course.
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*
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Name
*
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Last
Email
*
I hereby consent to verbal and/or written or electronic communication between Education Resource and other elements of the criminal justice system including my lawyer, the judge, the probation department, and/or any other referring criminal justice agency.
The purpose of and need for disclosure is to inform the criminal justice agencies of my attendance and progression in the DWII program.
I understand that this consent will remain in effect until there has been formal and effective termination or revocation of my probation, conditional release, or other proceeding under which I was mandated to the services of Education Resource.
I also understand that any disclosure made is bound by Part 2, Title 42 Code of Federal Regulations governing confidentiality of client records.
Consent
*
I agree to the consent for release
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