I hereby state that the aforementioned is a complete and accurate representation of my situation.
I understand that the Community Resource Center of Teton Valley (CRCTV) has an obligation to keep my personal information, identifying information, and my records confidential. I also understand that I can choose to allow CRCTV to release some of my personal information to certain individuals or agencies.
I have read the disclosure that appears above, I understand what I have read, and by my own will and with full knowledge I sign this document.