Please come back on August 27, 2019 for the updated 2019 Ontario Physical Activity Safety Standards in Education.

The website is currently being updated. Please come back on August 27, 2019 for the updated 2019 Ontario Physical Activity Safety Standards in Education.

Sample Return to Physical Activity Form (Non-Concussion Medical Illnesses/Injuries)

The Return to Physical Activity Form (Non-Concussion Medical Illnesses/Injuries) must be completed by parents/guardians and returned to the principal/designate for any student who has missed a physical education class due to an injury or illness requiring professional medical attention (for example, medical doctor, nurse practitioner, chiropractor, physiotherapist).

Name of Student:
Teacher:

Results of Medical Examination

As a result of my child’s/ward’s injury/illness, (insert injury/illness), medical attention by a (check one) [Medical doctor/Nurse practitioner/Other medical specialist] has been accessed with the following results (check appropriate box(es)):

No limiting features of the injury/illness have been observed and therefore he/she may resume full participation in physical activity with no restrictions.
Some features of the injury/illness remain which limit the ability to participate without restrictions. My child/ward may participate in physical activity following the accommodations to his/her physical activities listed below. (Accommodations must be provided prior to any physical activity taking place.)
A diagnosis that the injury/illness will prevent my son/daughter from participating in physical activity until further notice was received.
Refer to comments below and/or attached information.
Parent/Guardian signature:
Date:
Comments: