Epstein Secrets

if checked provide a copy) PBSD 0636 (Rev. 01/26/2005) page 1 of 2 EFTA01710040 STUDENT LEGAL NAME MN Rat middle) 9. Disclosures for entry into Palm Beach County School District (check all that apply) O The student has had Juvenile Justice actions taken against him/her. 0 The student has been expelled from School O The stud

with their current Florida school, fill in boxed areas below and complete Part A-2 on the reverse side of this form. • For additional information: Sec Immunization Guidelines for School and Child Care Facilities for information and instructions on form completion and immunization requirements. Guidelines arc available from the local county health department.

r Plan? (I Medi& provides copy) P650 0636 (Rev. oit2smos) pap 1 of 2 EFTA01710075 LEGAL NAME pea( 6* t .,, fS " b. Disclosures for entry into Palm Beach County School District (check all that apply) 0 The student has had juvenile justice actions taken against him/her. 011ie student has been expelled from school. 0 The s

with their current Florida school, fill in boxed areas below and complete Part 42 on the reverse side of this form. • For additional information: Sec Immunization Guidelines for School and Child Care Facilities for information and instructions on form completion and immunization requirements Guidelines arc available from the local county health department.

if checked provide a copy) PBSD 0636 (Rev. 01/26/2005) page 1 of 2 EFTA01727093 STUDENT LEGAL NAME MN Rat middle) 9. Disclosures for entry into Palm Beach County School District (check all that apply) O The student has had Juvenile Justice actions taken against him/her. 0 The student has been expelled from school O The stud

with their current Florida school, fill in boxed areas below and complete Part A-2 on the reverse side of this form. • For additional information: Sec Immunization Guidelines for School and Child Care Facilities for information and instructions on form completion and immunization requirements. Guidelines arc available from the local county health department.