Epstein Secrets

RMISSION FOR MY OVID TO & GAN HEALTH SCREENINGS. THESE. TESTS MAY BE GIVEN INCIYIOUALLY OR IN GROUPS. gi YES YES I NO (251 SODIELA FLUORIDE: I GM PERMISSION FOR MT CHILD TO PARTICIPATE IN THE SOCIUM FLUORIDE PROGRAM 6if YES TO FREVENT DENTAL MCAT. PERMISSION IS VALID THROUGH GRAM SIX. YES

back of Special Characteristics Card 5.Registration Forms - most recent on top 6.Cumulative Health Record - Immunizations. Birth Certificate and Physical Examination stapled in- side 7.Other legal information, such as court order, affi- davits and correspondence from community agencies 8.Standardized Test Data

Grade Tested 10 Achievement Level NT FCAT Score • NT FCAT Score 3000 Reading 2500- 2000- 1500- 1000- S00- Grade 9 Grade et Grade Grade I GM* Gracie a Grade Grad 10' 11+ • Your Score O On Grade Level You did not score well enough to pass the Grade 10 FCAT Mathematics lest. Your Math

ic Condition 0 Respiratory Illness 0 it Seizure Disorder 0_ Skin Disorder 0 Vl Vision Disorder 0 III Other (Specify) 0 Sof Report of Physical Examination Normal Abnormal If Abnormal, Explain • Height (inches) V • • Weight (pounds) V • Pulse ( ) I.Vr • Blood Pressure l/ • Hair/Scalp ve- •

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ovide documentation of the items checked below. YOUR CHILD HAY NOT ATTEND SCHOOL UNTIL THIS INFORMATION HAS BEEN PROVIDED. 1. T.B. Test 2. Physical Examination 3. Hepatitis B 4. DPT/ OT 5. Polio 6. MMR - 1st , 2nd 3rd . For the safety and protection of your child and the school system, sc