Women’s Legal Advocate Consent Form

I, name above, authorize Shauna Clare, Women’s Legal Advocate of the Skookum Jim Friendship Centre, to provide and/or receive information to/from:

I understand that only the information I have consented to will be discussed.  Any further information will require my being re-contacted for consent.  I further understand that this Consent Form is valid for 365 days from the day of signing at which time if I am still involved with the Women’s Legal Advocate of the Skookum Jim Friendship Centre I will need to sign and date a new Consent Form.