I hereby authorize The Warrior Alliance to share my information in its possession, including but not limited to my name, address, contact information, Protected Health Information, other personal information related to my situation and the type of assistance I am receiving, with other service and volunteer organizations participating in my case in order to coordinate available services and assistance. I acknowledge that I have been provided with a list of all organizations that may have access to my information and have been informed that if I wish to limit or refuse the release of information, I have had the opportunity to do so. I understand that I may revoke this consent at any time by contacting The Warrior Alliance, except when action has already been taken to obtain and/or release such information to organizations participating in my case coordination. I understand that I am responsible for providing the required information or documentation to access programs and services from The Warrior Alliance and its Community Partners and other local resources. It is also my responsibility to perform activities that may be required of me to access services and to maintain respectful, professional etiquette with The Warrior Alliance staff and all other partners and organizations. I acknowledge that failure to abide by these protocols could result in delayed or denied service. Submitting this form indicates that I have read the above, or had it read to me, and I understand the terms and conditions. I have also had the opportunity to ask any questions. I am also signing this release on behalf of my children that are under the age of eighteen (18), if applicable. List of TWA Community Partners: https://www.thewarrioralliance.org/services/#serviceprovider
