Syllabus Signature Page for Mrs. Miranda's Class Semester One
This form contains necessary information for your student's PE teacher. Please fill out the following
What Period does the student have PE?
Student's Name (Last, First)
Your answer
Emergency Contact Information
In case student is hurt during class, WHO (person's name) should the school contact?
Your answer
Emergency Contact Phone Number
Your answer
Parent/Guardian E-mail address
Your answer
Medical Information
Please list any medical conditions that your child has that might effect his/her ability to participate in Physical Education. Written verification from a doctor may be necessary. Please make sure the nurse is aware of any medical condition.
Your answer
Parent/Guardian Signature
By typing your name, you agree that you have read and understand the PE Department's syllabus AND Mrs. Miranda's High School Course 1 Syllabus. If you have any questions, please contact Mrs. Miranda.
Your answer
Student Signature
By typing your name, you agree that yo have read and understand the PE Department's syllabus AND Mrs. Miranda's High School Course 1 Syllabus. If you have any questions, please contact Mrs. Miranda.
Your answer
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