At the time of certification, a local agency shall inform an applicant or the parent, guardian, or caretaker of a child or infant applicant, of the following: The applicant may not engage in dual participation; The Program violations and the sanctions applicable to a participant, a child or infant participant's parent, guardian, or caretaker, or proxy for committing those violations; The importance of regularly picking up food benefits and food; The disqualification policy for failure to pick up food benefits and the number of months of nonparticipation resulting from the disqualification; The policy of not providing notification of disqualification to the participant when the participant fails to pick up food benefits; The right to a fair hearing if the participant does not agree with the disqualification for failure to pick up food benefits; How the local agency food delivery system operates and a list of authorized stores where food benefits may be redeemed; The available health services, where they are located, how they may be obtained, and why they may be useful; A participant or a child or infant participant’s parent, guardian, or caretaker shall notify the local agency of any change in life circumstances that would have an impact on Program eligibility; and A participant or a child or infant participant’s parent, guardian, or caretaker shall advise any designated proxy of the proxy’s obligations under the Program, Program violations, participant and proxy sanctions, and the authorized food stores. At the time of certification, the Program applicant or a child or infant applicant’s parent, guardian, or caretaker shall read, or the Program representative or a local agency staff person shall read to the individual, the following: “The rules for applying for WIC are the same for everyone;” “I can ask a WIC employee for a fair hearing if someone tells me I cannot be on WIC and I do not agree;” and “I will get information about healthy eating and active living. WIC will help and support me with breastfeeding. I will get information about immunizations and other services I might need.” After advising the applicant, or the child or infant applicant’s parent, guardian, or caretaker of the rights and responsibilities set forth in this regulation, the applicant or the child or infant applicant’s parent, guardian, or caretaker, shall read, or a Program representative shall read to the applicant, or the child or infant applicant’s parent, guardian, or caretaker, the following statements: “I understand what my rights and responsibilities are;” “I agree to follow the rules below. I will:(i) not sell, give away or trade my eWIC card, foods, or formula for money, credit, rain checks or other items. If I have WIC items I can’t use, I will return them to the clinic; (ii) not post WIC items for sale or trade on the internet; (iii) not swear, yell, harass, threaten, physically harm WIC or store staff, or damage WIC or store property; (iv) not enroll a child who is not in my legal or designated care; and (v) not enroll in WIC in more than one state or get benefits from more than one WIC clinic each month;” “The information I have provided for eligibility determination is correct, to the best of my knowledge;” “The information that I provide to the WIC Program is being submitted in connection with the receipt of federal assistance;” “Program officials may verify information provided to them;” “I understand and agree that intentionally making a false or misleading statement or misrepresenting, hiding, or withholding facts may result in my having to pay the WIC Program, in cash, the value of the food benefits improperly issued to me and may subject me to civil or criminal prosecution under State and federal law and disqualification from the WIC Program;” and “I agree to give true and complete information about changes in my life circumstances that would have an impact on my eligibility for WIC benefits (for example, I will notify WIC if I have changes in my income or family size or if I move).” The applicant or the child or infant applicant’s parent, guardian, or caretaker, shall acknowledge the reading of the statements enumerated in §C of this regulation by signing the Rights and Responsibilities form provided by the State agency.