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	EOC - 18900 Cortez Blvd, Brooksville
	Atria - 7030 Evergreen Woods Trail, Spring Hill
Child's Full Legal Name:
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If you have any specific questions that are not addressed on this form or experiencing issues submitting this form, please contact Amber McClanahan at 352-797-3680 for more information.

By clicking submit you certify that: 1. The information supplied in this application is true and correct to the best of your knowledge. 2. You grant the Hernando County Sheriff's Office permission to verify all information provided. 3. You are aware that a criminal history will be conducted by the Hernando County Sheriff's Office. 4. A denial of this application may occur if any false statements or misrepresentation of any facts are noted in the process. 5. If any blanks appear on the application it will not be considered.