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Radon Test Kit - Short Term Waiver

  1. Residential Radon Test Kit Form

    Sherburne County Health and Human Services $5.00 Short Term Radon Test Kit

  2. I agree to allow Sherburne County Health and Human Services to receive a copy of my test results. Results will be used to track radon trends in Sherburne County and surrounding areas. I understand that I may be contacted by a Sherburne County Radon Educator regarding my results to help me understand what I could do to reduce Radon in my home and thus reduce the risk for lung cancer.

  3. DATA PRACTICES:

    According to MN’s Data Practices Laws, all information gathered from this form and test results must be considered public data and be provided upon request. Occasionally researchers seeking radon trend data or an individual planning to purchase a piece of property may request such data. Typically, radon test data is aggregated and summarized with other data to help policy makers monitor and make planning decisions related to public health.

  4. By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature.

  5. Please Check if "I Agree"*

  6. Leave This Blank:

  7. This field is not part of the form submission.