CP&P 26-15
(rev. 10/2006)
State of New Jersey
DEPARTMENT OF CHILDREN AND FAMILIES
Division of Child Protection and Permanency
AUTHORIZATION FOR RELEASE OF INFORMATION
I authorize
(Name of agency or person)
to release information to
(Name of agency or person)
about me or my children,
(Print name of person(s) authorizing release, and/or children)
Signature
Signature
Date
Agency Representative
Date
Telephone
Local Office Address/Sponsoring Agency Address
CP&P adheres to existing laws and regulations regarding releasing or obtaining information about its clients.
(Administrative Order 2:01, N.J.S.A. 30:4-24.3 and N.J.S.A. 9:6-8.10a).
CP&P requires agencies receiving information from CP&P to respect the confidential nature of the material and to be aware
that there may be penalties for release of such information to unauthorized persons.
When a child is placed through CP&P, information regarding the child’s placement is shared with the Family Court and the
Child Placement Review Board.