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First, Middle Initial, Last
If your answer is yes, please list that person's name.
I certify that my answers are true and complete to the best of my knowledge and that intentional misrepresentations or omissions may be cause for the rejection of entrance into the detention facility.
By typing my electronic signature below and clicking submit button, I acknowledge the above information is a true and accurate representation, to the best of my knowledge, and that all of the above information is required for the YCDC to allow entrance into the detention facility.
This field is not part of the form submission.
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