Physical Education Permission Form
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Email *
Student Information
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Student Name
Special Health Needs/Requests
If "Yes", please explain in further detail
Allergies
If "Yes", please list allergies
Regular Medications
If "Yes", please list medications
Authorization
Authorization
I hereby certify that my child is in normal health and capable of safe participation in the Physical Education Sports Program. I assume all risks and hazards incidental to the conduct of this program. I hereby authorize The Greene School to obtain medical treatment for my child in the event that our Emergency Contact individual(s) and we (the parents/guardians) cannot be reached.
Parent Name
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