Epstein Secrets

an asterisk fl the program your child was in the longest.) 0 Fee for Services 0 Head Start 0 Pre-K Disabilities 0 Private Pre-K 0 School-based (Pre-K) 0 Teenage Parent Program 0 None 3. Is the student who Is enrolling in school a single parent? 0 Yes 0 No N 4. Students will receive non-Invasive

nt have any allergies? (if yes specify) f'Yes 0 No Allergy 1 18. Physician Name 1 J c•12,n APIA. 01/4.A Telephone Number Parental Consent for Release of Student Information I hereby give permission for the school or District to use my chikfs photograph, video Image, writing, voice recording, name, grade level, school n

th an asterisk lithe program your chid was in the longest.) O Fee for Services O Head Start O Pre-K Disabilities O Private Pre-K O School-based (Pre-K) O Teenage Parent Program O None 3. Is the student who is enrolling in school a single parent? O Yes O No N 4. Students will receive non-invasive

dents illnesses, behavior issues, medications or physical limitations. student will use. 18. Physician Name Telephone Number Parental Consent for Release of Student Information I hereby give permission for the school or District to use my chid's photograph, video image, varkig, voice recording, name, grade level, school na

an asterisk fl the program your child was in the longest.) 0 Fee for Services 0 Head Start 0 Pre-K Disabilities 0 Private Pre-K 0 School-based (Pre-K) 0 Teenage Parent Program 0 None 3. Is the student who Is enrolling in school a single parent? 0 Yes 0 No N 4. Students will receive non-Invasive

student have any allergies? (if yes specify) 'Yes CI No Allergy 1 18. Physician Name 1 J ce-4., inn tc,k Telephone Number Parental Consent for Release of Student Information I hereby give permission for the school or District to use my chikfs photograph, video Image, writing, voice recording, name, grade level, school n