Consent to Exchange Information Form Parent/Guardian First Last hereby gives consent for the exchange of information deemed appropriate for service delivery regarding (Child's Name) First Last This exchange of information is between Big Brothers Big Sisters of London and Area and the following School Board, Facility, Agency, or Individual:Signature of parent/GuardianDate MM slash DD slash YYYY SMS Verification Note: To revoke this consent, written notice must be submitted indicating your desire to cancel.By clicking Submit, I consent to the collection of this personal information in accordance with Big Brothers Big Sisters of London and Area's Privacy and Confidentiality Policy.EmailThis field is for validation purposes and should be left unchanged. Share: Facebook Google+ LinkedIn
