Physical Waiver

Period______

Dear Parent:
It is important that we as Physical Educators know the physical status of our students.
It is our recommendation that each student obtain a physical .
If this is not feasible then it is necessary that you as a parent accept
the responsibility for your student physical condition.
Any deviations or limitations should be brought to our attention immediately in writing.
Please use the bottom of this form to communicate any limitations.

* * * * * * * * * * * * * * * * * * * * *

I will accept the responsibility for the physical condition of
(Student Name please print)

___________________________________ and he or she may participate
in the Physical Education Program.

______________________________
(Parent Signature)

______________________ ______________________________
(Date) (Telephone Number)

Student limitations: