Consent to be Interviewed and Contacted by the CAC

I hereby consent to have my child interviewed by the Children’s Advocacy Center of Worcester County. I understand that this interview may be observed and/or recorded by audio or video devices, by representatives from various state and local agencies, including, but not limited to the Department of Children and Families, the Massachusetts State Police, or Local Police Department, the Worcester District Attorney’s Office, and/or by a physician, or nurse. I further understand that information obtained during the interview may be shared with these agencies to further assist my child. In the event that an investigation ultimately leads to a criminal trial, I understand that this tape-recorded interview does not replace the need for a child (witness) to testify in court.

I have read and fully understand the information in the brochure that was given to me, which describes the multi-disciplinary process. I additionally give permission for staff from the Child Protection Program at UMass Memorial Medical Center to contact me regarding resources and services that might be available for my child.
By Signing, I acknowledge that I have read and understand the above statement.(Required)

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