Epstein Secrets

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1154•CALCOu404 RA❑ aLlcaktal IIAACUAR 04 wow OYES • .4. "" M4APA4IP )g) LEGAL GUARDIAN (IC APO) R est eAs DOES LEGAL GUARDIAN HAVE CuSTOEY) El NO w,(ai LAST PC.it ACcilsi CITY ITA/1 2d COpI A .,. ,A ...,,,..... a Atm,. Arndt EMERGENCY HEALTH AND SAFETY INFORMATION PAnT I FERSOND) CINE

o ohcial de audiencias Cada una de las actor rice deben mantener una lista de les personas que s

r) C(FY STATE. ZIP CODE 2ocak Pa_k m P)dr‘ FJ45.3(11 STATE 2IP COCC RELATIONSHIP cart 111O1 ) EC (40) AUTHORIZED FOR El ENCY PICKUP YES El NO TELEPHONE RELATIONSHIP (42) AUTHORlaiD FOR EIAIRODCYNacuP K YES O NO (43) If school personnel are unable to contact you incase of ithess or acc

in Special Housing Unit Printed Name/Signature RICE, MARQUEA S II. RECCRD REVIEW (To be clone weekl

daily by Medical Staff Has been seen daily by responsible Gera designated by Warden: Yes; K No Has recanted prescribed weeldy exercise: IZ Yea; El NO Proper documentation and justification in the Central Fie (Incident Report. DHO Report copes or Special Housing Review Form): Yea El No If no. why