Get Chandler School District School Activity Restrictions Form

ADMINISTRATIVE MANUAL VIII B 22 SECTION HEALTH FORMS Chandler Unified School District 80 SCHOOL ACTIVITY RESTRICTIONS Restrictions from Physical Education sports and/or recess in excess of 5 days require a physician s written documentation. The following activity restrictions have been placed on by his/her doctor in light of his/her diagnosis of and treatment plan. These restrictions may change due to changes in his/her status and you will be notified of any changes. If you have any questions regarding appropriate activities please call. May participate in P. E* / sports / recess. May NOT participate in P. E* / sports / recess until no swimming no climbing no lifting lbs. Please circle all that apply Indoor activity only when temperature is above degrees. Please list any other restrictions not listed above Physician s Signature Date Phone Number Parent s Signature K Forms Book 07-08 Final1. If you have any questions regarding appropriate activities please call. May participate in P. E* / sports / recess. May NOT participate in P. E* / sports / recess until no swimming no climbing no lifting lbs. Please circle all that apply Indoor activity only when temperature is above degrees. May NOT participate in P. E* / sports / recess until no swimming no climbing no lifting lbs. Please circle all that apply Indoor activity only when temperature is above degrees. Please list any other restrictions not listed above Physician s Signature Date Phone Number Parent s Signature K Forms Book 07-08 Final1. If you have any questions regarding appropriate activities please call. May participate in P. E* / sports / recess. May NOT participate in P. E* / sports / recess until no swimming no climbing no lifting lbs. Please circle all that apply Indoor activity only when temperature is above degrees. Please list any other restrictions not listed above Physician s Signature Date Phone Number Parent s Signature K Forms Book 07-08 Final1.