I understand that the purpose of this release is to allow the coordination of services for myself, and/or my family, between the Post-Permanency Navigator (PPN) Program at Foster Adopt Minnesota and the above-named third party.

My electronic signature indicates that I have read this form and/or have had it read to me. I am aware of what information is to be disclosed and the potential consequences related to disclosure of personal information. I understand that I can contact the Post-Permanency Navigator Program with any questions or concerns.

This consent form expires one year from the date signed unless revoked by me in writing.