Please read and acknowledge the following:
I understand that the personal information I share will be held in the strictest confidence, except that which would violate the Florida Reporting Laws concerning child and elder abuse. I understand that the Women's Resource Center (WRC) is a grant-supported organization that receives funding from various funders, which may request access to any or all agency records related to the programs that they fund to evaluate or monitor the program delivery of service, and that I consent to the release of records for these purposes. Furthermore, I understand that any records provided by funders may become public records, may be subject to applicable state or federal exemptions, and may be inspected by a third party.
I also hereby permit the WRC to obtain and/or disclose my information or records needed for monitoring and follow-up purposes with partner organizations such as CareerSource Suncoast. I understand that I may revoke this consent at any time by providing a written statement indicating that my consent to releasing information is no longer given.
I certify the information I have provided is correct to the best of my knowledge. I understand that volunteers provide the services I receive at the WRC and/or dedicated staff members, and the information or referrals provided are intended as supportive information only. I agree that I am solely responsible for, and hold harmless, any decisions I make resulting from any information the WRC provides through its services and/or programs. I have signed this acknowledgment freely and voluntarily.