Epstein Secrets

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THE STUDENT A SINGLE PARENT^ Sin _I NO (23) HAS (Do Paid lee this school year in another Florida comfy as verified by receipt a H Paid fee in Pan Beach Count/ as verified by MONO # _..I I Exempt (25) ENTRY CODE: (26) ENTRY DATE: (27) WT DIST. j ADM j ESCL J ESE J MAD (28) TRANSPORTATION:

rvice Address: Riviera Bea L 33404 Phone: Expiration Date: (IS days after next Physician or Authorized Signatu A. 41/21-4goo/ w 7 3.0) •, Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 / c

FEAT Raids Caw*Mauva Assossmett Spring 2004 NAME: Florida Comprehensive Assessment Test (FCAT) ID: SCHOOL: NORM-REFERENCED TEST DISTRICT: 50 PALM BEACH Grade 10 Student Report This report shows your results from the FCAT National Nonn-Referenced Test. The FCAT Norm-Referenced Test measures your achi

sician or Clinic Name: (Print or stamp) Address: Expiration Date: (15 days after ant inuntuthafteei appointment) hvsician or ignature: Date: Permanent Medical Exemption PART C For medically contraindicated immun exemption: DOE Code 3 tions, list each vaccine and state valid clinical reasoning or evidence for I ce

ICS II SCIENCE 4KTextbook Assessments O EDL JR FCAT Diagnostic/ Practice Tests K Diagnostic Software O Other (see attached) O O O • K O Patin Beach Writes Portfolio Performance Assessments FCAT Diagnostic/Radice Tests Diagnostic Software Other (see attached) Wextbook Assessments O pooso O

• (Print or Stamp) Address: Expirati0n Date' _Olitlazufttstualimaadzatisin atipSathunD *LI Physician or Authorized Signature. Date. Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 I c

if adclutianal space needed) C. LABORATORY Hemoak>bin/Flematccse 1 I-17: I:2 DitIthrei -. .. ctri.,L.O5.; NAMI: TITLE ADD (PiirsiiA'0t(m) PALM BEACH BLVD. SUITE 201 ROYAL PALM sena'. FL 33411 F. Obsolete. previous 'dittos.) (Stock Nunber: 5744-000-3040-2) Stool (O PI Sickle Cell 30 . 9 L Tub

an or Clinic Name: (Print or stamp) Address: Expiration Date: (r9 dart after nest humanization appo Physician or Authorized Signature: Date: Permanent Medical Exemption PART C For medically contraindicated immunizations, list each vaccine and state valid clinical reasoning or evidence for exemption: DOE Code 3 I c