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</o:shapelayout></xml><![endif]--></head><body lang=EN-US link=blue vlink=purple><div class=WordSection1><p class=MsoNormal>Hello everyone,<o:p></o:p></p><p class=MsoNormal>I received the following flier from the Maryland School for the Blind about a short course they will be offering for middle school students on Saturday, January 23. Please see below, and contact Victoria Watt at the School for the Blind if you have any questions, or to register.<o:p></o:p></p><p class=MsoNormal>Thank you,<o:p></o:p></p><p class=MsoNormal>Melissa<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal align=center style='text-align:center'><o:p> </o:p></p><p class=MsoNormal><!--[if gte vml 1]><v:shapetype id="_x0000_t75" coordsize="21600,21600" o:spt="75" o:preferrelative="t" path="m@4@5l@4@11@9@11@9@5xe" filled="f" stroked="f">
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</v:shape><![endif]--><![if !vml]><img width=281 height=66 src="cid:image002.jpg@01D14DFA.B2953260" align=left hspace=12 alt="MSB_emailLogo365x86" v:shapes="Picture_x0020_3"><![endif]><span style='font-size:24.0pt;font-family:"Verdana","sans-serif";color:white'><o:p></o:p></span></p><p class=MsoNormal style='line-height:22.85pt;mso-line-height-rule:exactly;punctuation-wrap:simple;vertical-align:baseline'><b><span style='font-size:20.0pt;font-family:"Arial Narrow","sans-serif";color:#0070C0;letter-spacing:-.3pt'> <o:p></o:p></span></b></p><p class=MsoNormal style='line-height:22.85pt;mso-line-height-rule:exactly;punctuation-wrap:simple;vertical-align:baseline'><b><span style='font-size:20.0pt;font-family:"Arial Narrow","sans-serif";color:#0070C0;letter-spacing:-.3pt'> <o:p></o:p></span></b></p><p class=MsoNormal style='line-height:22.85pt;mso-line-height-rule:exactly;punctuation-wrap:simple;vertical-align:baseline'><b><span style='font-size:20.0pt;font-family:"Arial Narrow","sans-serif";color:#0070C0;letter-spacing:-.3pt'> A Short Course Program for Middle and High School Students<o:p></o:p></span></b></p><p class=MsoNormal align=center style='text-align:center'><span style='border:solid #0F243E 1.5pt;padding:0in'><img width=345 height=355 id="Picture_x0020_1" src="cid:image003.png@01D14DFA.B2953260" alt="http://bronxhouse.org/wp-content/uploads/2015/12/52191-New-Year-New-You.png"></span><span style='font-size:36.0pt;font-family:"Cambria","serif"'><o:p></o:p></span></p><p class=MsoNormal align=center style='text-align:center'><b><span style='font-size:36.0pt;color:#002060'>Saturday, January 23, 2016<o:p></o:p></span></b></p><p class=MsoNormal><b><span style='font-size:24.0pt;font-family:"Candara","sans-serif";color:#002060'> Location: </span></b><span style='color:#002060'> </span><b><span style='font-size:24.0pt;font-family:"Cambria","serif";color:#002060'>The Maryland School for the Blind<o:p></o:p></span></b></p><p class=MsoNormal align=center style='text-align:center'><b><span style='font-size:20.0pt;font-family:"Candara","sans-serif";color:#002060'> 10 AM to 3 PM<o:p></o:p></span></b></p><p class=MsoNormal align=center style='text-align:center'><b><span style='font-size:8.0pt;font-family:"Candara","sans-serif"'><o:p> </o:p></span></b></p><p class=MsoNormal style='text-align:justify'><b><span style='font-family:"Arial Narrow","sans-serif"'>Course Description: </span></b><span style='font-size:14.0pt;font-family:"Arial Narrow","sans-serif";color:#1F497D'>This is a great time of year to think about developing some new and healthier habits! Students will participate in activities that can help improve focus, sleep, balance, flexibility and fitness as well as increase body and spatial awareness. Instruction will include basic dance routines, exercise and fitness routines, and adapted yoga techniques that, In addition to physical health benefits, can also help students to better manage feelings and improve coping skills. Students will prepare a nutritious lunch and dessert while learning about healthy food choices through fun games and discussion. All activities will be taught by highly qualified and/or certified staff including: Susan Vanderhoff,</span><span style='color:#1F497D'> </span><span style='font-size:14.0pt;font-family:"Arial Narrow","sans-serif";color:#1F497D'>LCSW-C and Certified Yoga Instructor, Heather Browne, Experienced Dancer, Matt Mescall, Adaptive PE Teacher, and Genelle Hughes, Low Vision Rehabilitation Specialist. <o:p></o:p></span></p><p class=MsoNormal style='text-align:justify'><i><span style='font-family:"Arial","sans-serif"'>If you have any questions about the registration process, please contact Vicky Watt at 410-444-5000, ext. 1249.<b> Fax: 410-319-5708 COST: $10.00 per Student </b></span></i><b><i><span style='font-size:12.0pt;font-family:"Arial","sans-serif"'><o:p></o:p></span></i></b></p><p class=MsoNormal><i><span style='font-size:8.0pt;font-family:"Arial","sans-serif"'><o:p> </o:p></span></i></p><p class=MsoNormal><b><span style='font-family:"Arial","sans-serif"'>Ruth Ann Hynson, </span></b><span style='font-family:"Arial","sans-serif"'>Director of Statewide Outreach Services <b><o:p></o:p></b></span></p><p class=MsoNormal><span style='font-family:"Arial","sans-serif"'>The Maryland School for the Blind ~ Outreach Dept.<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial","sans-serif"'>3501 Taylor Avenue, Baltimore, MD 21236 <o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial","sans-serif"'>Baltimore, MD 21236<o:p></o:p></span></p><p class=MsoNormal align=center style='text-align:center'><!--[if gte vml 1]><v:shape id="Picture_x0020_2" o:spid="_x0000_s1026" type="#_x0000_t75" alt="Facebook-Icon_very small" style='position:absolute;left:0;text-align:left;margin-left:353.25pt;margin-top:17.45pt;width:12pt;height:12pt;z-index:251658240;visibility:visible;mso-wrap-style:square;mso-width-percent:0;mso-height-percent:0;mso-wrap-distance-left:9pt;mso-wrap-distance-top:0;mso-wrap-distance-right:9pt;mso-wrap-distance-bottom:0;mso-position-horizontal:absolute;mso-position-horizontal-relative:text;mso-position-vertical:absolute;mso-position-vertical-relative:text;mso-width-percent:0;mso-height-percent:0;mso-width-relative:page;mso-height-relative:page'>
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</v:shape><![endif]--><![if !vml]><img width=16 height=16 src="cid:image005.jpg@01D14DFA.B2953260" align=left hspace=12 alt="Facebook-Icon_very small" v:shapes="Picture_x0020_2"><![endif]><span style='font-family:"Arial","sans-serif";color:black'> <a href="http://www.marylandschoolfortheblind.org"><span style='color:black'>www.marylandschoolfortheblind.org</span></a> </span><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif"'><o:p></o:p></span></b></p><p class=MsoNormal align=right style='text-align:right'><span style='font-size:12.0pt;font-family:"Arial","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal align=center style='text-align:center'><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal><i><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></i></p><p class=MsoNormal style='margin-left:2.0in;text-indent:.5in'><i><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></i></p><p class=MsoNormal><i><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></i></p><p class=MsoNormal style='margin-left:2.0in;text-indent:.5in'><i><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></i></p><p class=MsoNormal style='margin-left:2.0in;text-indent:.5in'><i><span style='font-size:14.0pt;font-family:"Arial","sans-serif"'>Short Course Program - A New Year and New You!<o:p></o:p></span></i></p><p class=MsoNormal align=center style='text-align:center'><b><i><span style='font-size:14.0pt;font-family:"Arial","sans-serif"'>Registration<o:p></o:p></span></i></b></p><p class=MsoNormal align=center style='text-align:center'><i><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></i></p><table class=MsoNormalTable border=1 cellspacing=0 cellpadding=0 style='margin-left:-.05in;border-collapse:collapse;border:none'><tr><td width=744 valign=top style='width:7.75in;border:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt'><p class=MsoNormal><b><i><span style='font-family:"Arial","sans-serif"'>PARTICIPANT INFORMATION:<o:p></o:p></span></i></b></p><p class=MsoNormal><b><i><span style='font-size:8.0pt;font-family:"Arial","sans-serif"'><o:p> </o:p></span></i></b></p><p class=MsoNormal><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial","sans-serif"'>Student: ________________________________________ DOB: ___________________________<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial","sans-serif"'>Grade: ___________ School: ____________________________________________________<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial","sans-serif"'>Parent(s): _________________________________________________________________________<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial","sans-serif"'>Address:_______________________________ City:_________________ State:____ Zip:__________<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial","sans-serif"'>County: _____________________________ Vision Teacher: ________________________________<o:p></o:p></span></p><p class=MsoNormal><span style='font-size:8.0pt;font-family:"Arial","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial","sans-serif"'>Home Phone: _________________________ Cell Phone: ______________________________<o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial","sans-serif"'>Email: ___________________________________ Siblings: ____________________________ <o:p></o:p></span></p><p class=MsoNormal><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></p></td></tr></table><p class=MsoNormal><i><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></i></p><table class=MsoNormalTable border=1 cellspacing=0 cellpadding=0 width=732 style='margin-left:.9pt;border-collapse:collapse;border:none'><tr style='height:423.15pt'><td width=732 valign=top style='width:549.0pt;border:solid windowtext 1.0pt;padding:0in 5.4pt 0in 5.4pt;height:423.15pt'><p class=MsoNormal><b><i><span style='font-family:"Arial","sans-serif"'>VISUAL INFORMATION </span></i></b><b><i><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'>(Students are required to bring portable low vision or Braille devices and canes):<o:p></o:p></span></i></b></p><p class=MsoNormal><b><span style='font-size:10.0pt;font-family:"Arial","sans-serif"'><o:p> </o:p></span></b></p><p class=MsoNormal style='line-height:150%'><span style='font-family:"Arial","sans-serif"'>Eye Condition:_________________________________ <o:p></o:p></span></p><p class=MsoNormal style='line-height:150%'><span style='font-family:"Arial","sans-serif"'>Level of Vision: ___ Totally Blind ___ Partially Sighted ___ Legally Blind ___ Wears Glasses <o:p></o:p></span></p><p class=MsoNormal style='line-height:150%'><span style='font-family:"Arial","sans-serif"'>Field Loss: ___ Yes ___ No<o:p></o:p></span></p><p class=MsoNormal style='line-height:150%'><span style='font-family:"Arial","sans-serif"'>Child uses the following for learning: ___ Regular Print ___ Large Print ____ Braille ___ Auditory Skills <o:p></o:p></span></p><p class=MsoNormal style='line-height:150%'><span style='font-size:8.0pt;line-height:150%;font-family:"Arial","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal style='line-height:150%'><span style='font-family:"Arial","sans-serif"'>Travel Skills: ___Independent ___Needs Supervision ___Uses Cane ___Prefers Sighted Guide<o:p></o:p></span></p><p class=MsoNormal style='line-height:150%'><span style='font-size:8.0pt;line-height:150%;font-family:"Arial","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal style='line-height:150%'><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal style='line-height:150%'><b><i><span style='font-family:"Arial","sans-serif"'>ADDITIONAL INFORMATION:<o:p></o:p></span></i></b></p><p class=MsoNormal style='line-height:150%'><span style='font-family:"Arial","sans-serif"'>Other Disabilities: ___________________________________________________________________________________<o:p></o:p></span></p><p class=MsoNormal style='line-height:150%'><span style='font-size:8.0pt;line-height:150%;font-family:"Arial","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal style='line-height:150%'><span style='font-family:"Arial","sans-serif"'>Medications your child currently takes: _____________________________________________________________________________________<o:p></o:p></span></p><p class=MsoNormal style='line-height:150%'><span style='font-family:"Arial","sans-serif"'>_____________________________________________________________________________________<o:p></o:p></span></p><p class=MsoNormal style='line-height:150%'><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal style='line-height:150%'><b><span style='font-family:"Arial","sans-serif"'>Allergies: <o:p></o:p></span></b></p><p class=MsoNormal style='line-height:150%'><span style='font-family:"Arial","sans-serif"'>Medication (describe) __________________________________________________________________<o:p></o:p></span></p><p class=MsoNormal style='line-height:150%'><span style='font-family:"Arial","sans-serif"'>Food (describe) ______________________________________________________________________<o:p></o:p></span></p><p class=MsoNormal style='line-height:150%'><span style='font-family:"Arial","sans-serif"'>Environmental (describe)________________________________________________________________<o:p></o:p></span></p></td></tr></table><p class=MsoNormal><i><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></i></p><p class=MsoNormal><b><i><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></i></b></p><p class=MsoNormal><b><i><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></i></b></p><p class=MsoNormal><b><i><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></i></b></p><p class=MsoNormal><b><i><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></i></b></p><p class=MsoNormal><b><i><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></i></b></p><p class=MsoNormal><b><i><span style='font-family:"Arial","sans-serif"'><o:p> </o:p></span></i></b></p><p class=MsoNormal><b><i><span style='font-family:"Arial","sans-serif"'>RELEASE STATEMENTS: </span></i></b><i><span style='font-size:12.0pt;font-family:"Arial","sans-serif"'><o:p></o:p></span></i></p><p class=MsoNormal><span style='font-size:8.0pt;font-family:"Arial Narrow","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal style='text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial Narrow","sans-serif"'>Photo Release: </span></b><span style='font-size:14.0pt;font-family:"Arial Narrow","sans-serif"'>Many pictures are taken during the programs of various activities. These pictures are sometimes used, along with press releases, to provide public relations information to television stations, newspapers and other publications. I grant permission for my family to be photographed for the above purposes. <o:p></o:p></span></p><p class=MsoNormal style='text-align:justify'><span style='font-family:"Arial Narrow","sans-serif"'> <b>___ Yes ___ No<o:p></o:p></b></span></p><p class=MsoNormal><span style='font-size:8.0pt;font-family:"Arial Narrow","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal><b><span style='font-size:12.0pt;font-family:"Arial Narrow","sans-serif"'><o:p> </o:p></span></b></p><p class=MsoNormal><b><span style='font-size:18.0pt;font-family:"Arial Narrow","sans-serif"'>Please note: Wear comfortable clothing and tennis shoes, this program requires physical activity.<o:p></o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><span style='font-size:12.0pt;font-family:"Arial Narrow","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><span style='font-family:"Arial Narrow","sans-serif"'><o:p> </o:p></span></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-family:"Arial Narrow","sans-serif"'>Please fax or mail registration to:<o:p></o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><i><span style='font-family:"Arial Narrow","sans-serif"'>The Maryland School for the Blind <o:p></o:p></span></i></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><span style='font-family:"Arial Narrow","sans-serif"'>Outreach Department<o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><span style='font-family:"Arial Narrow","sans-serif"'>3501 Taylor Avenue <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><span style='font-family:"Arial Narrow","sans-serif"'>Baltimore, MD 21236 <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><i><span style='font-family:"Arial Narrow","sans-serif"'>ATTN: Victoria Watt</span></i><span style='font-family:"Arial Narrow","sans-serif"'> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><span style='font-family:"Arial Narrow","sans-serif"'>Phone: 410-444-5000 ext. 1249 <b>FAX: 410-319-5708</b> <o:p></o:p></span></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><span style='font-family:"Arial Narrow","sans-serif"'>Email: <u>victoriag@mdschblind.org</u></span><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'> <o:p></o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal align=center style='text-align:center;line-height:115%'><b><span style='font-size:14.0pt;line-height:115%'>The Maryland School for the Blind</span></b><b><span style='font-size:14.0pt;line-height:115%;font-family:"Times New Roman","serif"'><o:p></o:p></span></b></p><p class=MsoNormal align=center style='text-align:center;line-height:115%'><b><span style='font-size:8.0pt;line-height:115%'><o:p> </o:p></span></b></p><p class=MsoNormal align=center style='text-align:center;line-height:115%'><b><span style='font-size:14.0pt;line-height:115%'>PHYSICAL ACTIVITY FORM<o:p></o:p></span></b></p><p class=MsoNormal align=center style='text-align:center;line-height:115%'><b><span style='font-size:14.0pt;line-height:115%'>School Year 2015-2016<o:p></o:p></span></b></p><p class=MsoNormal align=center style='text-align:center;line-height:115%'><b><span style='font-size:14.0pt;line-height:115%'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-left:.25in;line-height:115%'><b><span style='font-size:14.0pt;line-height:115%'>*If you completed this form during the summer program you will not need to duplicate.<o:p></o:p></span></b></p><p class=MsoNormal align=center style='text-align:center;line-height:115%'><span style='font-size:12.0pt;line-height:115%'><o:p> </o:p></span></p><p class=MsoNormal align=center style='text-align:center;line-height:115%'><o:p> </o:p></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:115%'>Student Name: <u> </u> Date of Birth: <u> <o:p></o:p></u></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:115%'><u><o:p><span style='text-decoration:none'> </span></o:p></u></p><p class=MsoNormal style='margin-bottom:10.0pt;line-height:115%'><b><u>Adapted Physical Education</u></b><u> </u>- All students have Adapted Physical Education as part of their curriculum. Please indicate below if there are any medical reasons for exception.<o:p></o:p></p><p class=MsoNormal style='line-height:115%'>Adapted Physical Education<o:p></o:p></p><p class=MsoNormal style='line-height:115%'><o:p> </o:p></p><p class=MsoNormal style='line-height:115%'> (Example: Age appropriate skill development, fitness & activities) <span style='font-family:Wingdings'>o</span> No exception <o:p></o:p></p><p class=MsoNormal style='line-height:115%'> <o:p></o:p></p><p class=MsoNormal style='line-height:115%'> Exception: <u> <o:p></o:p></u></p><p class=MsoNormal style='line-height:115%'><o:p> </o:p></p><p class=MsoNormal style='line-height:115%'>Adapted Aquatics: goggles required for students with M.D. orders <span style='font-family:Wingdings'>o</span> No exception<o:p></o:p></p><p class=MsoNormal style='line-height:115%'><o:p> </o:p></p><p class=MsoNormal style='line-height:115%'> Exception: <u> <o:p></o:p></u></p><p class=MsoNormal style='line-height:115%'><u><o:p><span style='text-decoration:none'> </span></o:p></u></p><p class=MsoNormal style='line-height:115%'>Adapted Recreation (Example: Skiing, Bowling, Horseback Riding) <span style='font-family:Wingdings'>o</span> No exception<o:p></o:p></p><p class=MsoNormal style='line-height:115%'><o:p> </o:p></p><p class=MsoNormal style='line-height:115%'> Exception: <u> <o:p></o:p></u></p><p class=MsoNormal align=center style='text-align:center'><o:p> </o:p></p><p class=MsoNormal style='line-height:115%'><o:p> </o:p></p><p class=MsoNormal><u> </u> <u> </u> <u> </u><u><o:p></o:p></u></p><p class=MsoNormal>Physician’s Signature Date Physician Phone Number <o:p></o:p></p><p class=MsoNormal><u><span style='font-size:14.0pt'><o:p><span style='text-decoration:none'> </span></o:p></span></u></p><p class=MsoNormal><u> </u> <u> </u><u><span style='font-size:12.0pt'><o:p></o:p></span></u></p><p class=MsoNormal>Parent/Guardian Signature Date<o:p></o:p></p><p class=MsoNormal><o:p> </o:p></p><p class=MsoNormal><span style='font-size:8.0pt'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:8.0pt'>CD/LB/cic:4/1/14<o:p></o:p></span></p><p class=MsoNormal style='punctuation-wrap:simple;vertical-align:baseline'><span style='font-size:12.0pt'><o:p> </o:p></span></p><p class=MsoNormal><span style='font-size:10.0pt'><o:p> </o:p></span></p><p class=MsoNormal style='punctuation-wrap:simple;vertical-align:baseline'><span style='font-size:12.0pt'><o:p> </o:p></span></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal style='margin-bottom:6.0pt;text-align:justify'><b><span style='font-size:14.0pt;font-family:"Arial","sans-serif";color:red'><o:p> </o:p></span></b></p><p class=MsoNormal><o:p> </o:p></p></div>
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