DFS - Clients - Consent to Share Information (BSP)

Consent to Share Information

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Today's Date *

The participant (or someone authorised to do so on their behalf) consents to DFS sharing the following records with any government department or authority responsible for authorisation of restrictive practices concerning the participant in order to help it exercise that responsibility:

A) This plan

B) Any report that the Commission receives about the use of restrictive practices concerning the participant

I attach a copy of evidence of the consent
*

Participant Name

Participant Signature

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Name of Parent / Guardian(If required)

Parent / Guardian Signature

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(If required)