School Excuse

 

Child's name __________________________________________________ 


Diagnosis _____________________________________________________ 


This child was home for medical problems from _______________ to 

_____________________. 

This child is now able to return to school and is not contagious.  


Physical education:

___ Full activity 

___ Limited activity as follows: 

_______________________________________________________________

_______________________________________________________________

_______________________________________________________________

No gym for _____ days 


Physician's name ______________________________________________

Physician's signature ________________________ Date ___________

Physician's phone number _________________________