Epstein Secrets

Retain Mr Indicate: Promote (P) Retain (R) - Indicate: Promote (P) Retain (A) 01-93d0 EFTA01709793 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 232.032, s. 64D-3.011, F.A.0 and s. 65C-22.006, F.A.C. LAST NAME J PARENT OR GUARDIAN D i r e t t i o n C • Enter all appropri

Tardies O Check Homework O Encourage Reading at Home O Reinforce Skills O Attend Parent Conferences O Sign Daily/ treekly Notes K Attend Parent Curriculum/ Information Meetings 681 (REV. 8/12/2003) ORIGINAL - Cumulative Folder COPY • Te SIGMA! ant 0. r'AlteNT IGWNQAN er r-• •aren ua wan [Alt EFTA01709800 Studer! l

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Tardies O Check Homework O Read with Child Every Night O Reinforce Skills O Attend Parent Conferences O Sign Daily/Weekly Notes K Attend Parent Curriculum/ Information Meetings DATE SIGNATURE OF PARENT / GUAR0fAN SIGNATURE OF TEACHER PBSD 1687 (REV. 9/13/2002) ORIGINAL - Cumulative Folder COPY - Teacher COPY Parent/Gua

be between 1750 and 1856. NT-Not Tested NR-Not Reported Data Run Date: 11/22/2004 0115263 EFTA01710024 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 232.032,8.64D-3.011, F.A.0 ands. 65C-22.00C F.A.C. FIRST Child'sSW (optional) MIAR IM DO MO/DA/YR STATEIMMUNIZATION ID#' Dire

Tardies O Check Homework O Read with Child Every Night O Reinforce Skills O Attend Parent Conferences O Sign DailyNVeekly Notes O Attend Parent Curriculum/ Information Meetings DATE SIM 1523-n03 SIGNATURE OF TEACHER OATS PBSD teeT (REV. 9/13/2002) ORIGINAL - Cumulative Folder COPY - Teach 3/4/ EFTA01709981 THE SCHO

(46f DATA ENTRY COMPLETED BY DATE S/ DATE PBSD 0636 (REV. 4/6/20015.29/2001) page 2 of 2 EFTA01710389 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 232.032, s. 10D-3.088, F.A.C. and s. 10M-12, F.A.C. LAST NAME PARENT OR GUARDIAN Directions: • Enter all appropriate doses and

ment/Contribution Check as that appiy D Monitor Attendance / 'rarefies EI Read with Child Every Night O Attend Parent Conferences O Attend Parent Curriculum/ Information Meetings O Check Homework O Reinforce Skills O Sign Daily/Weekly Notes GNATCR£ OF PARENT/ GUARDIAN DATE SIGNATLPE OF PEIS0 1697 (REV. 9/11/20021 ORIGI

I PHYSICIAN OR CONIC NAME (PLEASE PRINT) JATELY IMMUNIZED AGAINST 'DANCE. -//,1/2,73 DATE EFTA01710101 FLORIDA CERTIFICATION OF IMMUNIZATION Legal Authority: FLORIDA STATUTES 232.032, a 10D-3.088, F.A.C. and S. 10M-12, F.A.C. ATE PARENT OR GUARDIAN FIRS I MI DOB moinAnta Child's 5Stt (optional) ST

Itment/ContributIon Check all that appty. O Monitor Attendance / Tardles K Encourage Reading at Home O Attend Parent Conferences K Attend Parent Curriculum/ Information Meetings K Successfuly Remediated O Requires New AIP Next School Year O Successfully Remediated O Requires New AIP Next School Yew 1171S111/121SIIIINCE