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 I give my consent to the JAS to share information about me or my case to my lawyer, the Court or the Police. Information will help others understand my disability so I can understand what is happening in my case. Receive info I give my consent for the JAS to be given information about me or my case from my lawyer, the Court or the Police. Information sharing with the JAS will help me understand what is happening in my case. Get info I give my consent to the JAS to get information from services and to share information with services to support me achieve my goals. Consent time 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 * Client Signature * Clear Use finger or mouse to sign Date * Submit
