Release of Information*
1)
I have been notified by Wishes and Rainbows, and understand that they feel it necessary to contact ________________________________________, a third party concerning my assistance request in order
I have been notified by Wishes and Rainbows, and understand that they feel it necessary to contact ________________________________________, a third party concerning my assistance request in order for me to get the best possible assistance.
2)Wishes and Rainbows, requesting permission to use my story, and/or information on their web site, in
Wishes and Rainbows, requesting permission to use my story, and/or information on their web site, in their portfolio, or as otherwise requested below, have notified me.
I, _______________________________________________, do give Wishes and Rainbows permission
to use the information I have provided to them for the reason below.
_________________________________________________ Signature
_______________________________ Date
Other reason for release of information
To be used for information for grants or other information required by the government. ____________________________________________________________________________
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