START Training
Parent Permission ~ ‘13-14
I, _______________________________________________ agree to allow members of the
START Training Team at the __________________________________ Intensive Training site
to observe, review relevant information (including my child’s IEP), and/or discuss my child
_____________________________________________, as part of a case-study requirement for
the START Intensive Training. I understand that my child’s first name and relevant background
information will be used as part of these discussions, but that START Team members will sign a
confidentiality waiver to assure privacy. Further, no information regarding my child will be used
or discussed outside of the START Training Team unless I agree and sign an additional
information release form.
I also agree to allow my child to be videotaped and photographed as part of this training.
Pictures and videos will only be used to the extent that they assist the team in learning about
autism and identifying and documenting results of implemented interventions. Further, only
members of the START Training Team designated above will view any photos or video, unless I
agree and sign an additional information release form.
By signing below, I agree to the above information. I understand that I am considered a part of
my child’s team; and thus am invited to the training sessions where my child will be discussed.
Should any concerns throughout the year arise, I understand that I may contact the Team Leader
at the site designated above or a START staff member.
This release of confidential information remains in effect for the 2013-2014 school year.
_________________________________________
Parent(s) Signature
_____________________
Date