Fillable CONSENTIMIENTO PARA TOMAR FOTOGRAFIA (Westside Regional Center)

Fill Online, Printable, Fillable, Blank CONSENTIMIENTO PARA TOMAR FOTOGRAFIA (Westside Regional Center) Form

Use Fill to complete blank online WESTSIDE REGIONAL CENTER pdf forms for free. Once completed you can sign your fillable form or send for signing. All forms are printable and downloadable.

CONSENTIMIENTO PARA TOMAR FOTOGRAFIA (Westside Regional Center)

On average this form takes 1 minutes to complete

The CONSENTIMIENTO PARA TOMAR FOTOGRAFIA (Westside Regional Center) form is 1 page long and contains:

  • 0 signatures
  • 0 check-boxes
  • 5 other fields

Country of origin: US
File type: PDF

Use our library of forms to quickly fill and sign your Westside Regional Center forms online.

BROWSE WESTSIDE REGIONAL CENTER FORMS

Related forms
Fill has a huge library of thousands of forms all set up to be filled in easily and signed.
Fill in your chosen form
Sign the form using our drawing tool
Send to someone else to fill in and sign.
find another form
 
Committed To Providing Support And Services To People With Developmental Disabilities
5901 Green Valley Circle, Suite 320, Culver City, CA 90230-6953
(310)258-4000 FAX: (310)649-1024 www.westsiderc.org
CONSENTIMIENTO PARA TOMAR FOTOGRAFIA
CLIENTE: ______________________________
UCI: ______________________________
Por la presente autorizo al personal del Centro Regional del Oeste a que se tome una fotografía a la
persona cuyo nombre aparece en este documento y la que será archivada en su expediente. Esta
fotografía no será reproducida y no será mostrada a otras personas que no sean del personal de el
Centro Regional sin la autorización de el cliente, padres, guardián o tutor legal.
En caso de que el cliente se llegue a extraviar, el, sus padres, guardián o tutor legal dan su autorización
para que se muestre su fotografía a la policía para que le ayude a localizarlo. Esta fotografía es
información confidencial y no debe de mostrarse solo con la excepción y de acuerdo a la provisión
hecha en el Código de Institución y Beneficia Sección 4514.
_____________________________
Firma del Cliente (Mayor de 18 años)
_____________________________
Padres, Guardián, Conservador Legal, Tutor Legal
_____________________________
Fecha
Revisado:8-22-13
Download
Save PDF to desktop
Email
Email completed PDF
Send for Signing
Email for others to sign
Print
Print document
Choose a Field
Click on a field and
select the person that should complete it
Want to add a signature?
You can add a signature field
and assign it to someone else
to sign
Choose a Field
Click on a field and
select the person that should complete it

CONSENTIMIENTO PARA TOMAR FOTOGRAFIA (Westside Regional Center)

This document is locked as it has been sent for signing.

You have successfully completed this document.

Other parties need to complete fields in the document. You will recieve an email notification when the document has been completed by all parties.

This document has been signed by all parties.

Completed 7 February 2021

Message

View Audit Log
Print With Audit Log
Duplicate Document