I certify that all of the above information I have provided is true and correct to the best of my knowledge. I understand this information will be verified, and false information will be grounds for youth to be terminated from his/her job or program. Possible legal actions can ensue if the youth is placed in a government funded job. I grant permission for myself/my child to receive medical services arranged by Carroll County Government for a work-related injury. I grant permission for the Carroll County Workforce Development (CCWD) to use my/my child’s image and/or voice in any and all forms of electronic or print media for purposes that promote CCWD and/or Carroll County Government.