YOUNG CHILDREN’S PROGRAM
College of Education
James Madison University
PERMISSION TO SHARE INFORMATION
Name of child _________________________________________________
Name of Adult family member ________________________________________
I give permission for ___________________________________ of the James Madison
(name of teacher)
University Young Children’s Program to share information about the above-named child
with _________________________________________________________________.
(name of agency or individual)
___________________________
Date
______________________________________________
Signature of adult family member
(An original copy of this document must be maintained in the
child’s records at the Young Children’s Program.)