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Physical Education Short-term Illness or Injury Restriction Report

About this Form

Form number: 345-22

Audience:  Parents/Guardians, Attending Physician, Principals

Last revised: June 2019

This form should be considered for completion if an authorized health care provider has indicated that a student’s physical activity should be restricted in physical education classes. The authorized health care provider may use this form to specify the nature and duration of the restriction.

Adobe PDF Physical Education Short-term Illness or Injury Restriction Report834 KEnglish

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