Consent to Videotape and Release Information

  • I hereby request and authorize agents or employees of the Children’s Advocacy Center of the Lookout Mountain Judicial Circuit (CAC-LMJC) to interview and videotape

  • I understand that videotaping of the interview and videotaping of subsequent sessions may occur. Further, I understand that information received from myself and / or the child named above may be released to the Catoosa, Chattooga, Dade, Gordon, or Walker County Department of Family and Children Services (DFCS), Law Enforcement officers investigating the incident, juvenile court personnel and representatives from the Lookout Mountain Circuit’s District Attorney’s Office. I also understand that all information obtained in the investigation of this case will be discussed at a multidisciplinary team case review meeting by members of the investigative team, which include but are not limited to DFCS representatives, Law Enforcement, CAC-LMJC personnel and representatives from the District Attorney’s Office. Discussion may include information obtained during videotaping. I understand that no information will be released to other persons without my (or an authorized person) signing an additional consent to release information form.

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