Release of Information
I, undersigned name, hereby authorize Pathway Education to obtain a copy of my court order, and communicate with listed attorneys, and court officials for the purpose of verifying, coordinating, and or reporting information related to my court ordered classes.
Purpose of Disclosure:
The information may be used or disclosed only for the purpose of my court, ordered classes.
Expiration:
This authorization is effective on the date, sign below and will remain in effect for the duration of my participation in the pathway education court ordered classes, unless revoked in writing.
Right to Revoke:
I understand that I may revoke the authorization at any time by submitting a written notice or email to pathway education LLC. I understand that revocation will not apply to information that has already been disclosed in reliance on this authorization.