Physician Release Form

Please have your physician fill out all the fields below and submit.

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Student's Name:
The above named individual is a patient of mine and/or after a thorough and complete examination, I recommend the following regarding participation in recreational classes at Whole Children / Milestones Rec, including martial arts, dance, gymnastics, yoga, and other movement including jumping, rolling, hanging, swinging, and turning up-side-down.
Physician Name: