Fraudulent Form Disclaimer:
By signing below, I certify that the information provided in this intake form is true, accurate, and complete to the best of my knowledge. I understand that submitting false, misleading, or fraudulent information is a violation of Blossom's policies and may result in the termination of assistance and/or legal consequences. I acknowledge that Blossom reserves the right to verify any information provided and take appropriate action if any discrepancies are found.