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Drug/Alcohol Declaration

I, _____________________________________________, am not habituated or addicted to depressants, stimulants, narcotics, alcohol

or other substances nor do I have a physical or emotional condition that may alter my behavior, interfere with the performance of my

duties or pose a potential risk to patients. The responses above are true to the best of my knowledge. I understand that any omissions,

error and/or misstatement of facts may be grounds for termination of my Bright Future for the Children LLC contract/employment. 

Thanks for submitting!

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