Authorization and Consent to Share Form

I certify that I am the parent or legal guardian of the learner, or otherwise have the legal authority to provide educational information on the learner’s behalf.

I voluntarily authorize Verbs Inc. Education to receive, review, store, and use the educational information and records that I provide, including, but not limited to, IEPs, Section 504 Plans, evaluations, report cards, assessments, school records, and other documentation relevant to the educational services I have requested.

I understand that this information will be used solely to provide educational services and will be handled in accordance with Verbs Inc. Education’s Privacy Policy.

By checking the boxes below and entering my name, I acknowledge that I have read and agree to this Parent Authorization & Consent.

Name of Learner(Required)
(Child/Student)
Name of Parents/Legal Guardians(Required)
Clear Signature

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