Epstein Secrets

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

l Services I Placement • Special Services! Placement • Other (see attached) O Other (see attached) K Deficiencies due to non-attendance (refer to Attendance Specialist) Number of Days Absent Parent/Guardlan Contact Commitment/Contribution Checkoff Mal apply. O Monitor Attendance / Tardies O Check Homework O Re

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

2EACH RET: COM GR: 10 0: 18 MATH: 43 READ: 276 MATH: 285 LEP: AIP: R-FZ W-ZZ M-FZ S-ZZ 504: O Deficiencies due to non-attendance (refer to Attendance Specialist) Number of Days Absent PartuittGuardlan Contact Commitment/ContrIbution Check./ thatapply. O Monitor Attendance I Tardies O Check Homework O Re

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

ment 0 Other (see enacted) 0 Other (see attached) 0 Other (see attached) K Other (see attached) [1] Deficiencies due to non-attendance (refer to Attendance Specialist) Number of Days Absent ParentlGuardlan Contact Commitment/Contribution Check as that appiy D Monitor Attendance / 'rarefies EI Read with Child E

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emediated ,,_. Requires New AIP Next Schott Year Special Senices 1 Placement Other (see attached) In Deficiencies due to non-attendance refer to Attendance Specialist) Number of Days Absent Parent/Guardian Contact CommItnentIContdbution O,ecl te 'het eppy. El Monitor Attendance I Tarries K Check Homework 0 Re