If you would like the Raising Riley Child Care Assistance Program to release your contact
information to parents seeking child care through:

• Raising Riley’s website

• Via email

• Family Child Resource Center

• Phone

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I give consent to the Raising Riley Child Care Assistance Program to release my name, address, and telephone number as a licensed child care provider to parents seeking child care.This consent is valid from the date below until I submit a written request otherwise, or until I close my child care business.