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Disclosure and Medical Form for PE
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* Indicates required question
Student Last Name
*
Your answer
Student First Name
*
Your answer
Parent Name
*
Your answer
Teacher Name
*
Ms. Tanzer
Mr. Jenson
Student Grade
*
6th grade
7th grade
Period Student has PE
*
1st
2nd
3rd
4th
5th
6th
Trimester in PE
*
(If your student has PE multiple trimesters, please check all that apply)
Trimester 1, 2019-2020
Trimester 2, 2019-2020
Trimester 3, 2019-2020
I have read the information in the disclosure and understand the expectations of my student in PE.
*
Yes
No
Please check one of the following concerning your child's health:
*
My student has no health-related concerns while participating in Physical Education at Sunrise Ridge
My student has health-related concerns while participating in Physical Education at Sunrise Ridge
If applicable, please briefly list the health concerns that concern you in a Physical Education setting:
Your answer
Please list any other concerns or relevant information about your student that will help to make Physical Education a more enjoyable experience.
Your answer
What is your preferred method of contact?
(cell or email - please write number and/or address)
Your answer
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