I, the undersigned parent/guardian, consent to the participation of my child in the Connecting Kids to Care Program, and understand that their demographic and outcome data will be used by the Children's Board of Hillsborough County to analyze the success of the program.

I understand that the information obtained will be kept confidential and will only be shared with authorized personnel involved in the administration of the Connecting Kids to Care Program and the Children's Board of Hillsborough County.

Yo, el padre/guardián abajo firmante doy mi consentimiento para la participación de mi hijo/a en el Programa Conectando Niños al Cuidado de Salud y entiendo que el Children's Board de Hillsborough County utilizará sus datos demográficos y datos de resultados para analizar el éxito del programa.

Entiendo que la información obtenida se mantendrá confidencial y solo se compartirá con el personal autorizado que participa en la administración del Programa Conectando Niños al Cuidado de Salud y el Children's Board de Hillsborough County. 

Mwen menm, paran/gadyen legal ki siyen anba a, mwen bay konsantman pou pitit mwen patisipe nan Pwogram Konekte Timoun ak Swen an, epi mwen konpwann ke done demografik ak rezilta li yo pwal itilize pa Children’s Board of Hillsborough County pou analize siksè pwogram nan.

Mwen konpwann enfòmasyon yo jwenn nan ap rete konfidansyèl epi se sèlman pèsonèl otorize ki enplike nan administrasyon Pwogram Konekte Timoun ak Swen an ki pwal pataje yo ak Children's Board of Hillsborough County.