Parent Request For Fitness Assessment Results Form printable pdf download

Parent Request For Fitness Assessment Results Form

UNITED INDEPENDENT SCHOOL DISTRICT

PHYSICAL EDUCATION 2009-2010

Parent Request for Fitness Assessment Results

STUDENT NAME:________________________________

GRADE:________________

(Please Print) STUDENT ID:____________

CAMPUS:_______________________________________

PE TEACHER’S NAME:_____________________________

PARENT’S NAME:_________________________________

PHONE #:____________________

(Please Print)

PARENT’S SIGNATURE:_____________________________

DATE:_______________________

REQUEST RECEIVED BY:____________________________

DATE:_______________________

(Please Print)

REPORT PRINTED BY:______________________________

DATE:_______________________

(Please Print)

REPORT RECEIVED BY:______________________________

(Please Print)

SIGNATURE OF RECEIVER:____________________________

DATE:________________________

Please return form to the front office or your child’s physical education teacher. Allow 3‐5 school days for

report to be printed. You will be contacted at the number you provided when the report is ready for pick‐up.

You must sign for the report before it will by released.

If you have any questions about the FITNESSGRAM Report, please contact Lisa Haberkorn, Physical Education

Coordinator (956) 473‐7100 or refer to

It is the policy of the United Independent School District not to discriminate on the basis of race, color, national origin, sex, or disability in the Career and

Technology programs, services or activities, as required by Title VI of the Civil Rights Act of 1964, as amended; Title IX of the Educational Amendments

of 1972; the Age Discrimination Act of 1975, as amended; and Section 504 of the Rehabilitation Act of 1973, as amended.