Epstein Secrets

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

ENESS Obterves Accurately Makes Comparisons Predicts outcomes Phases Siondisant Questions 13.1 13.2 133 13.4 2nd 3rd 4th man MATHEMATICS NUMERATION 'Matches Ole-D•One 14.1 'Names Numerals 0-10 14.2 'Matches Sets and Numerals to 10 14.3 'identities Ordiral Positron 14.4 FRACTIONS •Ident

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

1.0 V/PICTURE • 14/ 15 HI RETENTION 15/ 15 HI BEGINNING SOUNDS 8/ 8 HI MATHEMATICS PURPOSE GIVEN IN ADVANCE 5/ 5 HI ENDING SOUNDS 7/ 8 AV NUMERATION 17/ 21 AV PURPOSE NOT GIVEN IN ADVANCE 10/ 10 HI VISUAL DISCRIMINATION 6/ 6 Av PROBLEM SOLVING 6/ 6 HI ORGANIZATION 14/ 15 NI LETTERS 2/ 2

(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

aces of Sounds AUDITORY MEMORY Repeats Sound Pattern Repeats Sentence 'Secuences Numerals 'Fathers Oirecticns 'Searences Letters MATHEMATICS NUMERATION 'remits One-to-One ' games Numerals 0-10 ' Matches Sets and Numerals to 10 identifies Ordinal Position FRACTIONS Identities One Half GEOMETRY

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

S Observes Accurately Makes Comparisons Predcts Outcomes Phrases Significant Questions 2nd 3rd 4th 13.1 13.2 13.3 MATHEMATICS 2nd 3rd 4th NUMERATION 'Matches One•t0One 'Names Numerals 0.10 'Matches Sets and Numerals to 10 14.1 14.2 14.3 'Identifies Ordinal Position 14.4 FRACTIONS 'Ident