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The information provided on this application is true and accurate to the best of my knowledge. I agree to allow Frederick County Division of Aging and Independence staff to complete a phone assessment and home visit/evaluation prior to being considered for Meals on Wheels/Home Delivered Meals services. I agree to allow Frederick County Division of Aging and Independence staff to share information with other staff, healthcare providers, partner agencies, and with representatives of agencies currently providing me with services, as appropriate. I agree to notify the Division of Aging and Independence if information on my application changes (i.e. emergency contact information). I have read and understand the Meals on Wheels/Home Delivered Meal criteria for service and the contribution policy and I would like to be contacted by a Division of Aging and Independence staff person to continue the application process.
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