Wellness Exemption Agreement

You must submit this form for each student you have enrolled at Wilton Community School District in grades 7-12.

In 2008, the Iowa Legislature enacted “the Healthy Kids Act,” requiring that all students in grades 6-12 engage in physical activity for a minimum of 120 minutes per week in which there are at least five (5)days of school. The law also requires that we monitor how students fulfill this requirement.

Please indicate the Individual Physical Activity Plan you will be following during this year. This plan must include 120 minutes of activity per week or about 24 minutes per day. This includes any movement, manipulation, or extension of the body that can lead to improved levels of physical fitness and quality of life.

By checking any of these activities means your student is getting at least 35 more minutes a week participating in a physical activity in addition to the PE class your student is required to take as part of our graduation requirements.

Student's Full Legal Name *
Your answer
Student's Grade *
FALL
WINTER
SPRING
Please type your full name below *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Wilton Community School District. Report Abuse - Terms of Service