The Children's Cancer Center has a partnership with St. Joe's Children's Hospital, Johns Hopkins All Children's Hospital, Tampa General Hospital, and Moffitt Cancer Center to provide services to patients being treated and their families by the division of pediatric hematology/oncology. In order to provide these services, certain patient information needs to be obtained.
I agree to release specific information on your child and family that would be used to match your child with the appropriate services and resources.
Children's Cancer Center, respects the confidentiality of client and volunteer records, and with the exception of situations listed below, shares information about clients and volunteers only among the agency professional staff. All records are considered the property of the agency and not he agency workers, clients, or volunteers, themselves. Records are not available for review by the clients or volunteers.
1. Information will be released to other individuals with non-CCC organization only with the client or volunteer's written consent.
2. Identifying information regarding clients and volunteers may be used in agency publications or promotional materials unless the client or volunteer requests otherwise.
I consent for all purposes to the reproduction and/or use of photographs of my child, my family, and myself (with or without the use of my name), by Children's Cancer Center, and by any nominee or designee of Children's Cancer Center (including any agency, client, periodical, or other publication) in all forms and media and in all manners, including advertising, trade, display, editorial, art, and exhibition. In giving this consent, I release Children's Cancer Center, their nominees and designees from liability for any violation of any personal or proprietary right I may have in connection with such reproduction or use.
I agree to email Sharin Nelson, Director of Programs and Family Services, snelson@childrenscancercenter.org, if I do NOT consent to my child's name and/or image used by the Children's Cancer Center in any form of media.