Other

Please check the following and sign below:

I attest that I have never been judged by the courts to be the parent of a child in need of protection, nor have I been convicted of abuse or neglect, or been the subject of a substantiated claim of abuse or neglect.

I attest that while caring for children I will not take any alcohol or narcotics or any other substance that may impair my ability to care for children.

I attest that all of the above information is true to the best of my knowledge.

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