Son Shine Preschool
SonShine Preschool
Fletcher United Methodist Church
50 Library Rd.
Fletcher, NC 28732
(828) 684-2902 Fax (888) 736-6561
Physical Examination (Must be completed and signed by examining physician)
Weight________________ Height________________ Heart______________Chest______________
Throat ________________ Neck _________________Abdomen_____________________________
Neurological System_________________________________________________________________
Teeth ____________ Skin ___________ Head __________ Eyes ___________ Ears_____________
Results of Tuberculin Test, if given:____________________________________________________
(Type) (Results)
Should activities be limited? _____________________________________________________________________________
______________________________________________________________________________
IMMUNIZATION HISTORY
A copy of immunizations are required to attend SonShine Preschool
Physician’s Signature____________________________________
Office Address__________________________________________
Telephone No. __________________________________________
Date of Examination_____________________________________
*State Law G.S. 130-87 requires DPT vaccines, three doses of oral polio vaccine all by the age of one and the measles occurring before age two.
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