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

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

ck one only) Both Parents 0 Mother 0 Father 0 Foster 0 Group Home 0 Student is ward of the state O

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

ck one only) Both Parents 0 Mother 0 Father 0 Foster 0 Group Home 0 Student is ward of the state O

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