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    Sca Pe Exemption Form

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    EshaaAyisha Riaz
    This document is a medical release form from physical education practicals for Saint Catherine Academy. [1] It allows students with a signed physician's note to modify their PE program based on their personal physical limits and acquire lifelong skills. [2] A temporary or permanent medical condition would not exclude a student from PE, as participation is encouraged at some level as long as a student is healthy enough to attend school. [3] The form requires a physician's diagnosis and recommendation for exemption or limited participation in PE activities.

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    Sca Pe Exemption Form

    Uploaded by

    EshaaAyisha Riaz
    29 views1 page
    This document is a medical release form from physical education practicals for Saint Catherine Academy. [1] It allows students with a signed physician's note to modify their PE program based on their personal physical limits and acquire lifelong skills. [2] A temporary or permanent medical condition would not exclude a student from PE, as participation is encouraged at some level as long as a student is healthy enough to attend school. [3] The form requires a physician's diagnosis and recommendation for exemption or limited participation in PE activities.

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    Original Title

    SCA PE EXEMPTION FORM

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    This document is a medical release form from physical education practicals for Saint Catherine Academy. [1] It allows students with a signed physician's note to modify their PE program based on their personal physical limits and acquire lifelong skills. [2] A temporary or permanent medical condition would not exclude a student from PE, as participation is encouraged at some level as long as a student is healthy enough to attend school. [3] The form requires a physician's diagnosis and recommendation for exemption or limited participation in PE activities.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as pdf or txt
    29 views1 page

    Sca Pe Exemption Form

    Uploaded by

    EshaaAyisha Riaz
    This document is a medical release form from physical education practicals for Saint Catherine Academy. [1] It allows students with a signed physician's note to modify their PE program based on their personal physical limits and acquire lifelong skills. [2] A temporary or permanent medical condition would not exclude a student from PE, as participation is encouraged at some level as long as a student is healthy enough to attend school. [3] The form requires a physician's diagnosis and recommendation for exemption or limited participation in PE activities.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    Saint Catherine Academy

    Medical Release from Physical Education Practicals

    Students with Physical Education Medical Release forms, signed by their physician, will be
    allowed to modify their program and to find their personal limits. The Physical Education Faculty
    believes this is a very important lifetime skill for students to acquire. A temporary/permanent
    handicap or illness, would not necessarily exclude that student from Physical Education.
    Generally, a student healthy enough to be in school should be able to participate in Physical
    Education at some level.

    Please have this form filled out and signed by your family’s licensed medical practitioner
    and returned as soon as possible.

    Name of Student: ______________________________ Class: _____________________

    Diagnosed Condition:
    _________________________________________________________________________________
    _________________________________________________________________________________
    _________________________________________________________________________________

    Date of Diagnosis: ___________

    Please place a tick mark in the table to indicate your recommendation for physical education
    practical below:

    Type of Exemption Temporary Permanent


    Partial Exemption/Limited participation
    Full Exemption/ No Participation

    If temporary, indicate the period of exemption.

    _____________________________________________________________________

    Indicate Activity Exemptions:

    Walking Running/aerobics Sprinting Push-ups


    Sit-ups Leg lifts Jump rope Sports

    Other Recommended Activities:


    _____________________________________________________________________________
    ___________________________________________________________________
    ___________________________________________________________________
    ___________________________________________________________________

    Physician’s Signature: ___________________ Physician’s Contact Number: __________________

    Parent/Guardian’s Signature _________________

    Parent/Guardian’s Contact Number______________

    Please note that ALL information will be held in strictest confidence. Please feel free to attach any other
    relevant information or you may use the back of this form to do so. Thanks for your assistance.

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