My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
CCP 04-21-2003
ArdenHills
>
Administration
>
City Council
>
City Council Packets
>
2000-2009
>
2003
>
CCP 04-21-2003
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
5/8/2007 1:18:20 PM
Creation date
11/14/2006 2:35:22 PM
Metadata
Fields
Template:
General (2)
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
57
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
<br />Exhibit 6 <br /> <br />e <br /> <br />NOTICE TO PERSONS UNDER AGE OF 18 <br /> <br />Some of the information you are asked to provide is classified as private under state law. You <br />have the right to request that some of all of the information not be given to one or both of your <br />parents/legal guardians, Please complete the form below if you wish to have information withheld. <br /> <br />Your request does not automatically mean that the information will be withheld. State law requires <br />the City to determine if honoring the request would be in your best interest. The City is required to <br />consider: <br /> <br />. Whether you are of sufficient age and maturity to explain the reasons and understand the <br />consequences, <br /> <br />. Whether denying access may protect you from physical or emotional harm, <br /> <br />. Whether there is reasonable grounds to support your reasons, and <br /> <br />. Whether the data concerns medical, dental, or other health services provided under <br />Minnesota Statutes 9144.341 to 144.347. If so, the data may be released only if failure to <br />inform the parent would seriously jeopardize your health. <br /> <br />NotiCE GIVEN To: <br /> <br />DATE: <br /> <br />e <br /> <br />BY: <br /> <br />(name) <br /> <br />(title) <br /> <br /> REQUEST TO WITHHOLD INFORMATION <br />I request that the following information: <br />Be withheld from: <br />For these reasons: <br />Date: Print Name: Signature: <br /> <br />e <br /> <br />5 <br />
The URL can be used to link to this page
Your browser does not support the video tag.