Epstein Secrets

ic (Print or Stamp) Add ACES, FLORIDA 33401 days after next Immunization appointment) Physician or Authorized Slgnat ed a schedule to I t o Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 cer

Tardies O Check Homework O Read with Child Every Night O Reinforce Skills O Attend Parent Conferences O Sign Daily/Weekly Notes K Attend Parent Curriculum/ Information Meetings DATE SIGNATURE OF PARENT / GUAR0fAN SIGNATURE OF TEACHER PBSD 1687 (REV. 9/13/2002) ORIGINAL - Cumulative Folder COPY - Teacher COPY Parent/Gua

• (Print or Stamp) Address: Expirati0n Date' _Olitlazufttstualimaadzatisin atipSathunD *LI Physician or Authorized Signature. Date. Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 I c

Tardies O Check Homework O Read with Child Every Night O Reinforce Skills O Attend Parent Conferences O Sign DailyNVeekly Notes O Attend Parent Curriculum/ Information Meetings DATE SIM 1523-n03 SIGNATURE OF TEACHER OATS PBSD teeT (REV. 9/13/2002) ORIGINAL - Cumulative Folder COPY - Teach 3/4/ EFTA01709981 THE SCHO

an or Clinic Name: (Print or stamp) Address: Expiration Date: (r9 dart after nest humanization appo Physician or Authorized Signature: Date: Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 I c

ment/Contribution Check as that appiy D Monitor Attendance / 'rarefies EI Read with Child Every Night O Attend Parent Conferences O Attend Parent Curriculum/ Information Meetings O Check Homework O Reinforce Skills O Sign Daily/Weekly Notes GNATCR£ OF PARENT/ GUARDIAN DATE SIGNATLPE OF PEIS0 1697 (REV. 9/11/20021 ORIGI

rvice Address: Riviera Bea L 33404 Phone: Expiration Date: (IS days after next Physician or Authorized Signatu A. 41/21-4goo/ w 7 3.0) •, Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 / c

Itment/ContributIon Check all that appty. O Monitor Attendance / Tardles K Encourage Reading at Home O Attend Parent Conferences K Attend Parent Curriculum/ Information Meetings K Successfuly Remediated O Requires New AIP Next School Year O Successfully Remediated O Requires New AIP Next School Yew 1171S111/121SIIIINCE