This government document is issued by Department of Education for use in Maryland
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https://www.google.com/url?client=internal-element-cse&cx=007821330218074952993:ugglyla9k1c&q=https://earlychildhood.marylandpublicschools.org/system/files/filedepot/2/ccsinformalproviderconsentform.pdf&sa=U&ved=2ahUKEwjhxfbR_YzxAhUZPOwKHSYrBt44ChAWMAZ6BAgJEAE&usg=AOvVaw2eGB4ybAmPuFrt0BYyO3UB