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expiration date. DOE Code 2 I certify that that the above named child has received the immunizations documented on complete the requi Physician or Clinic (Print or Stamp) Add ACES, FLORIDA 33401 days after next Immunization appointment) Physician or Authorized Slgnat ed a schedule to I t o Pe

ic (Print or Stamp) Add ACES, FLORIDA 33401 days after next Immunization appointment) Physician or Authorized Slgnat ed a schedule to I t o Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 cer

call (for kindergarten effective with the 200//7002 school year) for school attendance as documented on the reverse side of this form. Physician or Clinic Physician or (Print or stamp) uthorized Signatur Ad Date: Certificate of Immunization Supplement for 7ib Grade Requirement PART A-2 (Immunizat

Clinic Name: Expiration Date: (Print or sump) (15 days after next immunization appointment) Physician or Address: Authorized Signature: Date: Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 - -

call (for kindergarten effective with the 200//7002 school year) for school attendance as documented on the reverse side of this form. Physician or Clinic Physician or (Print or stamp) uthorized Signatur Ad Date: Certificate of Immunization Supplement for 7ib Grade Requirement PART A-2 (Immunizat

Clinic Name: Expiration Date: (Print or sump) (15 days after next immunization appointment) Physician or Address: Authorized Signature: Date: Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 - -