Epstein Secrets

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)

K Sixassluly Rernadaled O Regales Non' MP Nor SOS Year 0 Snail Sera I Pecirent O Otte (see eftscheci) O Deficiencies die to nonattendance OW to Attendance Specialist) Paant/Guardlan COMMItmenUCoritribUtiOn Ova as That •0•Y O Monitor Attendance I Tank** K Chock Homework O Encourage Rimdm3 at Home Reinforce Sk

cal reasoning or evidence for exemption: DOE Code 3 I certify that he 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) Address. Physician Signature. DN 680, &NS repbces earlier ed

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

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

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