• Physical Activity Modification Request Form


  • Part 1: To Be Completed By The Parent 


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    Pick a Date
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    Pick a Date

  • Part 2: To Be Completed By The Physician


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    Pick a Date
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    Pick a Date

  • Part 3: To Be Completed By The Physician

    Check all activities that you consider to be appropriate for the student to participate in. Remember that all activities will be modified for student's ability level.


  • Fitness:


  • Should be Empty: