ACADEMIC DAY SCHOOL INFORMED CONSENT PLACEMENT AGREEMENTInformed Consent Placement Agreement • January 11th, 2018
This Agreement is between , as the custodian of or the representative of the agency with custody of the above-named child, hereinafter referred to as “Custodian”, and the Dominion Youth Services, Inc., dba DOMINION ACADEMY, 1002 Wilmer Avenue, Richmond, VA 23227, hereinafter referred to as “DOMINION ACADEMY”, to wit:
