Authorization to Release Confidential Information - Cobb County ... - cobbk12 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the Student/Patient Full Name and Date of Birth in the designated fields. Ensure accuracy as this information is crucial for identification.
3. Next, fill in the Parent/Guardian Name and School. This section helps establish who is authorizing the release of information.
4. In the 'Person/Agency Releasing Records' section, provide the name, phone number, address, and fax of the individual or organization that will release the records.
5. Then, specify where these records will be forwarded by filling out the corresponding fields for another name/organization along with their contact details.
6. Indicate if you want a reciprocal release between agencies by checking the appropriate box.
7. Select which specific information you wish to be released by checking all applicable boxes under 'The following information is to be released.'
8. Finally, state the purpose for which this release is being requested by checking relevant options and sign at the bottom with date.

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