I hereby authorize Affordable Counseling & Educational Services (ACES) to disclose records
and information obtained in the course of my participation county certified domestic
violence treatment program to:
- Appropriate Courts
- Probation Officer
- Attorney
- Parole Officer
- The Identified Victim
- Officers of the Courts
This disclosure of the records authorized herein is required to inform the courts and those
agencies/agents directly involved of the participant’s status in the program. Such
disclosures include but are not limited to the following:
- Notification of Enrollment
- Progress Reports
- Terminations
- Documentation of Incidents
- Completions
- Recommendations of Concurrent Programs
- Information necessary to protect/warn the victim of domestic violence keeping in
compliance with the Tarasoff decision.
- All information requested by the courts or probation department
- All persons identified and authorized by myself
- Mandated Reporting requirements
This release shall remain in effect while I am a client of ACES and will terminate upon
completion of the program or termination from the program.
