Release Of Information, Records Consent {JU-03}

(Name of County) State of Alabama Unified Judicial System Form JU-3 Rev. 6/13 RELEASE OF INFORMATION/RECORDS CONSENT Court Case Number IN THE JUVENILE COURT OF __________________________________________________ COUNTY, ALABAMA (Name of County) In the Matter of ________________________________________________________________, a child (Name of Child) I, the parent/legal guardian/legal custodian of the above-named child, consent to the release of information and/or records from the following entities to the juvenile court staff on the above-named child; or consent to the release of information and/or records acquired or generated in the juvenile court concerning the above-named child to: _____________ Date ___________________________________ Parent/Legal Guardian/Legal Custodian ________________________________ (Signature) Date _____________ ___________________________________ Parent/Legal Guardian/Legal Custodian ________________________________ (Signature) The information and/or records which the above-signed person(s) have consented to be released are intended for the sole use of the individual or entity addressed above, and contain information that is confidential pursuant to Ala. Code 1975, § 12-15-133(g). This Section provides that any person who discloses or makes use of or knowingly permits the use of information identifying a child, or the family of a child, who is or was under the jurisdiction of the juvenile court, where this information is directly or indirectly derived from the records of the juvenile court or acquired in the course of official duties, upon conviction thereof, shall be guilty of a Class A misdemeanor under the jurisdiction of the juvenile court and also may be subject to civil sanctions. If the recipient of this information and/or records is not the intended recipient, the recipient is hereby notified that any disclosure of this information and/or records is strictly prohibited under Ala. Code 1975 § 12-15-133(g). If the recipient received this information and/or records in error, he or she must notify the sender immediately. INTAKE OFFICE: (Original) CLERK'S OFFICE: (Copy) PARENT/LEGAL GUARDIAN/LEGAL CUSTODIAN: (Copy) American LegalNet, Inc. www.FormsWorkFlow.com