WPC %fam˱ Xm"B:JP`m˸remNGlK\|0H Fo`c >]ga4 CMԎ6sՕi4v.$hI^)ݲįuޡ\r a*`8Q32 A"yMˌ;OF Īx@=8?O֠s!›X`ݾ(uF")*@M3q%/yYnv- Rk]{qC:"@/,Tx챔n^}1(sZެG&D2`z}:Y^Z7Ug^W7F yόNw@ڵ6b`جN01۩aʼn'X ~П|*7s|vl8m9RPnPQͅVSqzstTOOkM:Y)Yy3Ӡ0"'O2qUBnZZ % 0` UB U:6 UBp U:  0f #b (+NS^ Uwa4ey m{\  `*Times New RomanTT\  `*Times New RomanTTC\  P6QP\  `*Times New RomanTTXXP\  P6QXP2 `*Times New RomanTT P7P2 `*Times New RomanTTXX P7XP;6X9`("Courier NewTTTTXXv6X@CX@\  `*Times New RomanTT6\  P6QP<6X9`("Courier NewTTTTXXx6X@DQX@2 `*Times New RomanTT^^T P7^P'  $Wanda Johnson$0Wanda Johnson .   h:Default ParaDefault Paragraph Font        2 `*Times New RomanTT;6X9`("Courier NewTT\  `*Times New RomanTT<6X9`("Courier NewTT3|x (>$XtXXtXXXt\\HP\HP,,,,0!uJ4 Ф90:i+00U  !XtXXtXXXt  _XX  XXt @77$IMMUNIZATION XtXԈ X @!ChecklistorWaiver ,       CHECKLIST    ThestateofMichiganrequiresimmunizationforeverychildenrolledinapublicornonpublic  school.Verificationthatachildisappropriatelyimmunizedmustbemedicallycertifiedandmust L showthedateofeachdoseofvaccine.Thefollowingimmunizationsarerequired: l ZWXXtZWZW0  0` (#(#     HEPB `  BIRTH,12MONTHS&618MONTHS` (#` (# 0  0` (#(#0 ` (#` (# `     DTP `  2MONTHS,4MONTHS,6MONTHS,1518MONTHS&46YEARS (  (# (# 0  0` (#(#0 ` (#` (# `     _OPV_ `  2MONTHS,4MONTHS,1518MONTHS&46YEARS&   (# (# 0  0` (#(#0 ` (#` (# `     _HIB_ `  2MONTHS,4MONTHS,6MONTHS&1215MONTHS t  (# (# 0  0` (#(#0 ` (#` (# `     _MMR_ `  15MONTHS&46YEARSr   (# (# 0  0` (#(#0 ` (#` (# `     TD `  1416YEARS&EVERY10YEARSTHEREAFTER  (# (# XtXZWXtXXXt@^^'WAIVER  .   S  SInstructionstoParent/Guardian:Parentsmaywaivethehealthrecordrequirementformedicalor i  religiousreasons.Forparentswhoingoodconsciencechoosethisalternative,wehaveincluded 1  aWaiverofImmunizationwhichcansubstituteforthehealthrecordifcompletedandreturned  withtheApplicationforAdmission. i XFXXXtI/WEHEREBYWAIVEIMMUNIZATIONOF򀀀 Q Ѐ<XXFa<(Student'sName)XtXaXtXXXt  XFXXXtBECAUSEOF:XtXXXF(PleaseCheck)     XFXXXtGXtXX XF ` MedicalReasons h    XFXXXtGXtXX XF  ReligiousReasons {#    XFXXXtGXtXX XF ` Other.Explain:___________________________________________________     `    ____________________________________________________  򀀀 w ^0\XXtParent/GuardianSignatureDateXtX\^0Ԁ ?  򀀀 ! ^0\XXtParent/GuardianSignatureDateXtX\^0 w"   CURRICULUMSTATEMENT  &   PleasecheckorlistthecurriculumyouhavepurchasedfortheStudenttouseduringthe_____school_ r ( year. :!)    XFXXXtGXtXX XFԀ_Calvert_ԀSchool   XFXXXtGXtXX XFԀUniversityofNebraskaLincoln "r +    XFXXXtGXtXX XFԀOther(PleaseList):____________________________________________________ d$ "- Pleasel_ist_Ԁacademicsubjects(High 6%". School):___________________________________________ %#/ OrderDate:_______________ParentSignature:______________________________________ '6%1  ALLITEMSONTHISAPPLICATIONMUSTBECOMPLETEDBEFORESTUDENT )&3 WILLBEADMITTED.