ICATT Revocation of Consent

Please note, it may take up to 7 calendar days to process the revocation of consent from the ICATT program. If you wish to revoke consent please fill out the form below. 

REVOCATION (WITHDRAWAL) OF CONSENT FOR ICATT PROGRAM

  • Date Format: MM slash DD slash YYYY
  • I, the undersigned, revoke (withdraw) consent for the continued participation of my child, as indicated on this form, in the ICATT program.