Adult Culinary Program Application

I authorize Riverview Gardens to release and/or obtain information necessary to support my participation in the Adult Culinary Program. This may include communication with referring agencies, probation or parole officers, social service providers, employers, educational institutions, case managers, and other relevant support professionals. Information shared may include attendance, participation, program progress, completion status, employment readiness, and other updates related to my involvement in the program. I understand: This authorization is voluntary. I may revoke this authorization at any time by submitting a written request to Riverview Gardens, except to the extent that action has already been taken based on this authorization. This authorization remains in effect for the duration of my participation in the program unless revoked in writing. Information may be shared electronically (including email or secure digital platforms) for program coordination and support purposes. By checking the box below and typing my name, I acknowledge that I have read and understand this authorization and agree to its terms. I understand that my electronic signature is legally binding.