JAS Client Consent Form You can say YES. You can say NO. It is up to you.Ask questions if you do not understand or feel you want more facts. JAS Client Consent Form Full Name * Date * Date of Birth * I agree for JAS to support me (tick the boxes that apply): when I am at Court at the Police Station in my Legal appointment Share info to understand I give my consent for information about my case to be shared between the JAS and my lawyer, the court or police so that I can understand what it is happening in my case. share info to achieve goals I give consent for information to be shared between the JAS and other services to support me to achieve my goals. consent for current matter I understand this consent is only effective while the JAS is helping me with my current criminal justice matters. Don’t share info I do not want the JAS to share any information or talk to the following people or services. Excluded Services/People Case info I agree that information about my case can be given to researchers. I understand that my name will not be given and will stay private. Declaration I have explained the meaning of this form to the client and declare the record of their consent is accurate. Name of person explaining this form * Date * Client Signature * Clear Use finger or mouse to sign Submit Updated 21/7/22
