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doses of DTP. DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated. (Complete Part C for Pertussis contraindication.) 4 Td (Adult) Vaccine is recommended for children 7 years of age or older. s Polio 4 doses required. If the third dose is administered on or after the fourth birthday. a

LE JUSTICE ACTIONS? I TES OYES OYES RI NO J NO ri NO EFTA01709797 THE SCHOOL DISTRICT OF - NEW/RETURNING STUDENTS REGISTRATION BACK (31) STUDER' IDES WITH COCCI ONE? VBOTH PARENTS D MOTHER 0 FATHER :1 SHARED CUSTODY E OTHER 12) TRANSPORTED BY Stirlen will be tonspertod to, lien I by e

doses of DTP. 3 DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated. (Complete Part C for Pertussis contraindication.) Td (Adult) Vaccine is recommended for children 7 years of age orolder. $ Polio 4 doses required. If the third dose is administered on or after the fourth birthday, a

PROMOTED TO THE NEXT GRADE LEVEL AS OF: 06/14/00 • • FM-100•I Roy. II I Oil EFTA01709983 ASI4-31-C4P DENT RECORD/SUBJECTS 06/16/00 09.29.55 STUDER 351 GRADE 06 HR GOO PRO ST P SCHL CD NAME SEX F ETH W 0-PHASE ADD SCHL CD BIRTHD LAST SUB T 04/17/80 RECORD UPDT 04/17/00 LAST GRD UPDT 0

ses of DTP. s DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated (Complete Part C for Pertussis contraindication ) ▪ Td (Adult) Vaccine is recommended for children 7 years of age or older. Polio 4 doses required. If the third dose is administered on or after the fourth birthday, a fo

go /Oa te Am b., .,.. ri ,,,,, 'ha duaal) /ye_e•V-i-r --- ( 411 it THkRE A COURT ORDER RAIIII.NL EITHEA PARENT SHIM RCI,O s vIN A CONTACTING THE STUDER' DURING THE SCHOOI DAY) , 1 • • TES fro IF YES, PLEASE PROvIDE THE SCHOOL WITH A COPT OF TIE COUR1 ORDER /50 •C iGuARoso. DOL: e ATHER NA CUS