Epstein Secrets

IGHLST LEVEL OF EDUCATION COMPLETLD (OPPONL1) A O "" ".." B O "..lir C O"4" ... a ItIRADUATEI 1371 Ads HIGHEST LEVEL Or EDUCATION COMPLETED (OPTIONAL) wwrmw..., B O I'm` -;,saca„ C Deltic"' D O „..... -- --- “7,- E O ""-"'" 44 ,, -JOMI D O ' ' "'„, - E O ''""',":" „ (SR LEGAL GUARDIAN IIF

taple back of Special Characteristics Card 5.Registration Forms - most recent on top 6.Cumulative Health Record- Immunizations, E Certificate and Physical Examination staple( side 7.Other legal information, such as court order, davits and correspondence from comm. agencies 8.Standardized Test Data Card 9.Stat

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

back of Special Characteristics Card 5.Registration Forms - most recent on top 6.Cumulative Health Record - Immunizations. Birth Certificate and Physical Examination stapled in- side 7.Other legal information, such as court order, affi- davits and correspondence from community agencies 8.Standardized Test Data

SPITAL PROT:ROME 1501 LIST YOUR CHILD'S ILLNESSES, ALLERGIES OR OTHER PHYSICAL LIMITATIONS: aff 16I/ NAME OF CHILD SCHOOL ATTENDING STUDENT NO. (OPTIONAL) GRADE MATH OATE MI NAME OF CHILD SCHOOL ATTENDING STUDENT NO, (OPTIONAL) GRADE BIRTH DATE (53) NAME OF CHILD SCHOOL ArtFt.01M1Cr STUDENT N

ic Condition 0 Respiratory Illness 0 it Seizure Disorder 0_ Skin Disorder 0 Vl Vision Disorder 0 III Other (Specify) 0 Sof Report of Physical Examination Normal Abnormal If Abnormal, Explain • Height (inches) V • • Weight (pounds) V • Pulse ( ) I.Vr • Blood Pressure l/ • Hair/Scalp ve- •

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ovide documentation of the items checked below. YOUR CHILD HAY NOT ATTEND SCHOOL UNTIL THIS INFORMATION HAS BEEN PROVIDED. 1. T.B. Test 2. Physical Examination 3. Hepatitis B 4. DPT/ OT 5. Polio 6. MMR - 1st , 2nd 3rd . For the safety and protection of your child and the school system, sc