Epstein Secrets

ne only) te Both Parents 0 Mother 0 Father 0 Foster 0 Group Home 0 Student is ward of the state Ot

been arrested resulting in a charge. of applicable 10. AInd with whom the student lives (check one only) te Both Parents 0 Mother 0 Father 0 Foster 0 Group Home 0 Student is ward of the state Other 11. IMPORTANT, EVERYONE MUST ANSWER THIS QUESTION. A. Is there a visitation order or other court

DTaP is an acceptable alternative for one or more doses of DTP. 3 DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated. (Complete Part C for Pertussis contraindication.) • Td (Adult) Vaccine is recommended for children 7 years of age or older. Polio 4 doses required. If the third d

WITH: (chock ro D Mother 0 Father oth Parents 0 Foster 0 Group Home 0 Other ' (31) CUSTODY STATUS OF

. DTaP is an acceptable a0ernative for one or more doses of DTP. 3 DT (pediatric) is acceptable if Perrussis vaccine is medically contraindicated. (Complete Part C for Pcnussis contraindication.) • Td (Adult) Vaccine is recommended for children 7 years of age or older. s Polo 4 doses required if the third d

(check one) 0 Mother 0 Father 0 Both Parents 0 Foster 0 Group Home 0 Other (31) CUSTODY STATUS OF STU

DTaP is an acceptable alternative for one or more doses of DTP. 3 DT (pediatric) is acceptable if Pertussis vaccine is medically contraindicated. (Complete Part C for Pertussis contraindication.) 4 Td (Adult) Vaccine is recommended for children 7 years of age or older. s Polio 4 doses required. If the thir