Epstein Secrets

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

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

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

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

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

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