The adult Exceptional Family Member (EFM), a parent/legal guardian or custodian, or an agent acting pursuant to a power of attorney of the EFM or Child and Youth (CYP) participant completes it.
Signer: the signer must identify his/her relationship to the EFM and/or CYP participant and provide a mailing address.
Agencies: answer Yes if permission is being granted to exchange information to additional agencies or individuals and list them on the back; otherwise, answer No.
Authorization: effective for one year from date of signature unless revoked sooner by notifying the agencies or individuals orally or in writing.
Responses: responses should be sent to your Regional Director.
| Question | Answer |
|---|---|
| Form Name | NAVMC 11720 |
| Form Length | 2 pages |
| Fillable? | Yes |
| Fillable fields | 31 |
| Avg. time to fill out | 6 min |
| Edition | Rev 02-21 |
| Other names | NAVMC 11720, NAVMC11720, MCO 1710.30 consent form, Consent to Release Information, Marine Corps Family Care Programs consent |
| Official source | NAVMC 11720 (Rev 02-21), Marine Corps |
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