The-St-James-School

Page of 2 STATE DEFARTMENT OF HEALTH Child Care Encounter I District I Date NameW License No. Address 2) 96 ?im tion. di?aua Purpose i I I at 1 Director Mileage Start Mileage End County Telephone No. I TimeIn 55 Time Out Total Time Finings/Comments 1?1 4 )4 .1. -A a" lullurv1/54 I 1 1411444414 'vz14-4924 11.; if.? 4 it Jae/z em?MM?ZMI/?ntji/ y- . a 5mm {4mm WA - M70 I Jim Mmelet?o/m? . - I F1 hemgowep a Cents} Directoi/Designe?/Indi?dual CHIIH Car? Re?rcsenta rive Mississippi State Department of Health Revised 6-24~09 Form No. 287 egg 4 Child Care Encounter Date (Continuation) Nani/1125 t-Jamas? 3mm 256 W762qu P?mmym A . Saltwang Wain/LL . . I?m WM _1 314 .JM .111 _1 1431/1. 14,7414 .111! . (A ?14) :1 I (14 1?4! /1 1 . :quzM?sasWhite C0 Fac?i File 2% Yellowp opy? Ongfrator Cen telE Director/Designbe/Indi?dual are Representa 11' we MjSSissippi State Department of Health Revised 07-27-09 Form No. 277