Attach court order or letter from county social worker.
I understand that all information provided to Reach-Up Inc. regarding my family is stored on an electronic database. It may be shared with other services used by Reach-Up Inc., such as the MN State Immunization Registry. By signing this form, I affirm that I believe these facts are true and accurate. I understand that I am asked to prove my statements. I understand that I may be prosecuted for fraud and perjury if I knowingly give false information.