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Department of Human Services Community Youth Employment Program RELEASE FORM INDIVIDUAL Authorization for Release of Photograph, Voice Use of Likeness or Printed Quotes or Statements I hereby release
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Individual authorization for release is a document that allows an individual to authorize the sharing or release of their personal information to a specified party.
Individuals who wish to have their personal information shared with third parties, such as healthcare providers, insurers, or employers, are required to file an individual authorization for release.
To fill out an individual authorization for release, you need to provide your personal details, specify the information to be released, identify the recipient of the information, state the purpose for the release, and sign and date the form.
The purpose of individual authorization for release is to ensure that individuals have control over their personal information and can consent to its disclosure to others.
The information that must be reported includes the individual's name, contact details, the specific information being authorized for release, the recipient's details, the purpose of the release, and the date of signature.
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