Epstein Secrets

O Questioning O Summarizing Types of Writing K Ward/Sentenx writing O Paragraph Writing K Composito

IST YOLR DOW'S ILLNESSES. A.LERGiEs OR OTHER PHYSICAL LMITATIONS YOUR CHILDREN IN OTHER CHOOLS: :Ill NAME OF CHILD SCHOOL ATTENDING STUDENT NO. (OPTIONAL) GRADE OATH DATE tl 4IN — STUDENT NO. (OPTIONAL) GRADE 1531 NAME OF CHILD SCNOOI ATTENOING STUDENT NO. (OPTIONAL) GRADE BRIM DAVE 1641 NA

EACH FL 33411 t SA 1651 240 4004 OLOSATai &WARD. ALAS Oi sm4404•4444 nam ore 4.mnvmma m0m4 nal

GRACE BIRTH DATE 154) NAME OF GILD SCHOOL ATTENDING STUCENT NO (OPTIONAL) GRACE BIRTH DATE (55) NAME OF CHID SCHOOL AT HEADING STUCENT NO. (OPTIONAL) GRACE SIREN DATE ISO) I VERIFY THAT THE INFORMATION GIVEN IS TRUE AND ACCURATE TO THE BEST CF MT KNOWLEDGE. SIGNATURE OF PARENT OR AGE( GjAROIA

r 0 Father 0 Foster 0 Group Home 0 Student is ward of the state Other 11. IMPORTANT, EVERYONE MUST

tit C--k--- , n . KM.' IA Ia' AAA( a, .., WEST PALM BEACH FL 33413 nt . Ltett 1... (SI STUCENTS SOCIAL SEE UM TT NO. 161 HOME PHONE NJ. (OPTIONAL) 0/ SLR F 0 „tome IlD R CE V 0 INDIANC" 0 A ASIAN psLANorq 9 W Zia rr-LISPANIC I MALI I g oNt....e_nmspaic 9 H HISPANIC 0 M I

ul oad ittt Ft.00 = "Ilt= ▪ Career_. Oniroil Ward Unit! - urg halt al Is via int, 1 be AP lo War

ng cantons) D Specialized reporting (please complete Section Company Reporting and the Report Options form) SECTION - COMPANY REPORTING HIERARCHY (OPTIONAL) ;even levels of reporting are available. Each level can house up to 99,999 units. All Identification numbers are $ digits and right justified. ':e