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IST YOLR DOW'S ILLNESSES. A.LERGiEs OR OTHER PHYSICAL LMITATIONS YOUR CHILDREN IN OTHER CHOOLS: :Ill NAME OF CHILD SCHOOL ATTENDING STUDENT NO. (OPTIONAL) GRADE OATH DATE tl 4IN — STUDENT NO. (OPTIONAL) GRADE 1531 NAME OF CHILD SCNOOI ATTENOING STUDENT NO. (OPTIONAL) GRADE BRIM DAVE 1641 NA
ed. DTaP is an acceptable alternative for one or more doses of DTP. DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated. (Complete Part C for Pertussis contraindication.) 4 Td (Adult) Vaccine is recommended for children 7 years of age or older. s Polio 4 doses required. If the thir
S, ALLERGIES OR OTHER PHYSICAL LIMITATIONS: A) 0 lie 0007,110- cg, p'Airiel eiTeci , 1511 NAME OF CHILD Aiorc • SCHOOL ATTENDING STUDENT NO. (OPTIONAL) GRADE RIM DATE 1521 NAME Of CHILD SCHOOL ATTENDING STUDENT NO, (OPTIONAL) GRACIE BIRTH DATE (531 NAVE OF CHILD SCHOOL ATTENDING STUDENT NO
d. Mal is an acceptable alternative for one or moredoses of DTP. 3 DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated. (Complete Part C for Pertussis contraindication.) Td (Adult) Vaccine is recommended for children 7 years of age orolder. $ Polio 4 doses required. If the third do
(4, GUn IVG ADDRESS .C./.1 he mar MAW( a, , ',We 41;ar orES Vrilt, 4• Ml s., 4. cn, sr *Tr t, car rrAW isi metiers SOCIAL SECURITY NO. (OPTIONAL) 161 HOME >HONE N0. il) I remAte 3 SEX F MALE (8) . e I RACE AMERICAN INNAN OP ALASKAN NATIvE. B ' NON-HISPANIC D A ttl iCti:IC I
DTaP is an acceptable alternative for one or more doses of DTP. 3 DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated. (Complete Part C for Pertussis contraindication.) 4 Td (Adult) Vaccine is recommended for children 7 years of age or older. Polio 4 doses required. If the third d
GRACE BIRTH DATE 154) NAME OF GILD SCHOOL ATTENDING STUCENT NO (OPTIONAL) GRACE BIRTH DATE (55) NAME OF CHID SCHOOL AT HEADING STUCENT NO. (OPTIONAL) GRACE SIREN DATE ISO) I VERIFY THAT THE INFORMATION GIVEN IS TRUE AND ACCURATE TO THE BEST CF MT KNOWLEDGE. SIGNATURE OF PARENT OR AGE( GjAROIA
DTaP is an acceptable alternative for one or more doses of DTP. 3 DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated. (Complete Part C for Pertussis contraindication.) 4 Td (Adult) Vaccine is recommended for children 7 years of age or older. s Polio 4 doses required. If the thir
tit C--k--- , n . KM.' IA Ia' AAA( a, .., WEST PALM BEACH FL 33413 nt . Ltett 1... (SI STUCENTS SOCIAL SEE UM TT NO. 161 HOME PHONE NJ. (OPTIONAL) 0/ SLR F 0 „tome IlD R CE V 0 INDIANC" 0 A ASIAN psLANorq 9 W Zia rr-LISPANIC I MALI I g oNt....e_nmspaic 9 H HISPANIC 0 M I
DTaP is an acceptable alternative for one or more doses of DTP. 3 DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated. (Complete Part C for Pertussis contraindication.) • Td (Adult) Vaccine is recommended for children 7 years of age or older. Polio 4 doses required. If the third d
Entities connected to both OPTIONAL and Complete Part C

George W. Bush
PERSONLeon Black
PERSON
Palm Beach
LOCATION
Ghislaine Maxwell
PERSONTd (Adult) Vaccine
ORGANIZATIONFCAT Mathematics
ORGANIZATIONLegal Authority
ORGANIZATION
United States
LOCATIONPermanent Medical Exemption
ORGANIZATION
Palm Beach County
LOCATIONSunshine State
LOCATIONDescription of Grade 10
ORGANIZATION
Harry Reid
PERSONSe Harcourt
PERSONHarcourt
LOCATIONChemical
ORGANIZATIONEste estudiante tiene
PERSONDoug Band
PERSONTambién se
PERSONInformes
ORGANIZATION