THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW
ORGANIZATIONSec Immunization Guidelines for School and Child Care Facilities
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ing the school day? .0 YES 0 NO If YES, provide the school with a copy of the court order. PESO 0636 (REV. 5/29/2001) page 1 of 2 EFTA01709611 THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW AND RETURNING STUDENT REGISTRATION (36) FATHER OR LEGAL GUARDAN first rmcWe Hap SAD IIIIIII IIIII PU: Y giimOR4211 OR LEGAL GUARDIAN (last mAMM
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 are updated annually and arc available from the local
dent during the school day? U YES Wil0 provide the sotto& with a copy of the court order. PBSD 0636 (REV. 02/04/2002) page t o12 EFTA01710055 THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW AND RETURNING STUDENT REGISTRATION v - ! -. an k C A- t STATE ZIP COCE pa d 6. FL d3V I1 On l0Jtii Palm STATE ZIP CODE PL 334 1 ' 0OCU
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.
dent during the school day? U YES Wil0 provide the sotto& with a copy of the court order. PBSD 0636 (REV. 02/04/2002) page t o12 EFTA01727108 THE SCHOOL DISTRICT OF PALM BEACH COUNTY - NEW AND RETURNING STUDENT REGISTRATION I I- an - kOODUP eVitt Palm STATE ZIP COCE bud', FL 83Y 1 L CITY ..„ al m iatieeh a STATE ZIP COD
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.
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