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IL Camelot Care Centers Diana Screen Consent Form 2013-2025 free printable template

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This form is used to obtain consent for taking the Diana Screen®, a sexual risk screening test, which is a requirement for candidates seeking staff, volunteer, or foster care positions with children
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How to fill out IL Camelot Care Centers Diana Screen Consent

01
Obtain the IL Camelot Care Centers Diana Screen Consent form from the administrative office or their website.
02
Read through the entire consent form carefully to understand its purpose and the information being requested.
03
Fill in your personal information, including your name, address, date of birth, and contact details in the designated fields.
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Provide details regarding any medical history or relevant conditions as prompted on the form.
05
Review any instructions related to completing the Diana Screen, such as necessary preparations or requirements.
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Sign and date the consent form to indicate your agreement to the terms outlined.
07
Submit the completed form to the appropriate office or personnel as instructed, either in person or via email/fax.

Who needs IL Camelot Care Centers Diana Screen Consent?

01
Individuals seeking assessment or support services through IL Camelot Care Centers require the Diana Screen Consent.
02
Caregivers or guardians of minors or individuals unable to consent on their own need to complete this form on behalf of the person receiving services.
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IL Camelot Care Centers Diana Screen Consent is a formal document that allows individuals to consent to participate in specific care programs or screenings at Camelot Care Centers in Illinois.
Individuals seeking to participate in care programs or screenings at IL Camelot Care Centers must file the Diana Screen Consent.
To fill out the IL Camelot Care Centers Diana Screen Consent, individuals should complete the provided form by entering their personal information, signing, and dating the consent where indicated.
The purpose of the IL Camelot Care Centers Diana Screen Consent is to obtain permission from individuals to participate in specific screenings and care processes, ensuring that they are informed and agree to the procedures.
The information that must be reported on the IL Camelot Care Centers Diana Screen Consent includes the individual's name, date of birth, contact information, any relevant medical history, and a signature indicating consent.
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