LICE TREATMENT VERIFICATION FORM

PLEASE RETURN THIS FORM TO THE SCHOOL.

I have treated my child, with

, shampoo on

Parent or Guardian Signature

.

Date

PLEASE RETURN THIS FORM TO THE SCHOOL AFTER THE SECOND TREATMENT HAS BEEN COMPLETED IN EIGHT TO TEN DAYS.

I have treated my child, with

, shampoo on

Parent or Guardian Signature

.

Date

Lice Treatment Verification.pdf

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