|
|
Print and fill out the health form and return to the Physical Education Department at Blue Ridge Elementary.
Physical Education Health Form
Student’s Name ______________________
Home Phone ______________ Cell Phone _________
Student’s Birthday ________________
Homeroom Teacher __________________
Parent’s Name ______________________
Address ________________________________
____ NO. My child has no health problems or restrictions at this time.
____ YES. My child has the following health concerns. (Please describe below)
Comments: Please include medications that we should know about. Include directions for procedures that you would like us to follow in case of an emergency-this is only necessary if you checked yes above.
** We have read and reviewed the policies for Physical Education at Blue Ridge Elementary School and agree to support and follow them. (Dress code, participation, rules, and discipline)
Parent’s signature _____________________
Child’s signature ______________________
|
|
