Epstein Secrets

nical reasoning or evidence for exemption: DOE Code 3 I cent& that the physical condition of this child is such that immunizations) as indicated in Pan C above is medically contraindicated. Physician or Clinic Name: (Print or stamp) Physician Signature: Address: DII 450, Pd2000, obsoletes whet

SCHOOL TRANSFERRING FROM (20) CITY /STATE icouNre COUNTRY (21) LAST ATTENDANCE DATE (22) LAST GRADE LEVEL (23) Have you ever been enrolled In a Palm Beach County School? 0 YES 0 NO If yes, what school? _ 200 DATE ATTENDED IN PBC All new and returning students compete the remaining form including page 2 (2s) Stud

inical reasoning or evidence for exemption: DOE Code 3 I cestift that the physical condition of this child Lt nth that immenitatiomNat indicated in Pan C above is medically caltraindicated. Physician or Clinic Name: (flint or stamp) Address: D44 610, 1196. dada= la (4Omo (SIM Maher 574.11O:MX1106)

F SCHOOL TRANSFERRING FROM (20) cm /STATE I COUNTY COUNTRY (21) LAST ATTENDANCE DATE (22) LAST GRADE LEVEL (23) Have you ever been enrolled in a Palm Beach County School? If yes, what school? 0 YES • NO (24) DATE ATTENDED N PBC All now and returning students compete the remaining form including page 2 12 NBR:1SS

nical reasoning or evidence for exemption. DOE Code 3 1 cent that the physical condition of this child is such that immunization(s) as indicated in Pan C above is medically contraindicated. Physician or Clinic Name: (Print or stamp) Physician Signature: Address: DH 680, 8/2000, obsoktm tallitt

E Cf SCHOOL TRANSFERRING FROM (20) WWI STATE I COUNTY =WRY (21) LAST ATTENDANCE DATE (22) LAST GRADE LEVEL (23) Have you ever been enrolled In a Palm Beach County School? DYES 0 NO If yes, what school? (21) DATE ATTENDED IN PBC All new and returning students compete the remaining form including page 2 rzsi Student