Epstein Secrets

Not Hispanic 0 American Indian/Native Alaskan 0 Black, Not Hispanic 0 Asian/Pacific Islander Sit • L

taple back of Special Characteristics Card 5.Registration Forms - most recent on top 6.Cumulative Health Record- Immunizations, E Certificate and Physical Examination staple( side 7.Other legal information, such as court order, davits and correspondence from comm. agencies 8.Standardized Test Data Card 9.Stat

EX RACIAL/ETHNIC GROUP MVVhite, Not Hispanic O Black, Not Hispanic U Hispanic O American STUDENT NU

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

nder O i - American Indian/Alaskan Native O B - Black Non-Hispanic O H - Hispanic O W - Whke, Non-His

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