NY Clarence Middle School Activity Restriction Form 2019-2025 free printable template
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PHYSICAL EDUCATION
ACTIVITY RESTRICTION FORM
STUDENTS NAME: ___
Provider: Please complete all 3 parts. CMS Health Office pH. (716) 4079223PART 1 Place a check mark next to the RESTRICTED ACTIVITY:
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How to fill out NY Clarence Middle School Activity Restriction Form
01
Obtain the NY Clarence Middle School Activity Restriction Form from the school office or website.
02
Carefully read the instructions provided on the form.
03
Fill in the student's full name and grade level at the top of the form.
04
Indicate the specific activities that the student is restricted from participating in.
05
Provide any necessary medical documentation or notes from a physician if applicable.
06
Complete the parent or guardian section, including their name, contact information, and relationship to the student.
07
Sign and date the form to verify the information provided is accurate.
08
Submit the completed form to the school's administration office or designated staff.
Who needs NY Clarence Middle School Activity Restriction Form?
01
Students who require restrictions due to medical conditions, injuries, or other personal reasons need the NY Clarence Middle School Activity Restriction Form.
02
Parents or guardians of students who need to officially communicate any activity limitations to the school.
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What is NY Clarence Middle School Activity Restriction Form?
The NY Clarence Middle School Activity Restriction Form is a document used by the school to track and manage students' participation in school activities based on medical or behavioral restrictions.
Who is required to file NY Clarence Middle School Activity Restriction Form?
Parents or guardians of students who have specific medical or behavioral needs that may limit their participation in school activities are required to file the NY Clarence Middle School Activity Restriction Form.
How to fill out NY Clarence Middle School Activity Restriction Form?
To fill out the NY Clarence Middle School Activity Restriction Form, parents or guardians should provide the student's personal information, a description of the restrictions, any relevant medical details, and signatures as required.
What is the purpose of NY Clarence Middle School Activity Restriction Form?
The purpose of the NY Clarence Middle School Activity Restriction Form is to ensure that the school is informed of any restrictions students may have, allowing staff to provide appropriate accommodations and ensure student safety.
What information must be reported on NY Clarence Middle School Activity Restriction Form?
The information that must be reported on the NY Clarence Middle School Activity Restriction Form includes the student's name, date of birth, details of the restrictions, the reason for the restrictions, and contact information for the parent or guardian.
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