Waukesha West Boys Track Doctors Excuse

 

Waukesha   W est   B oys   T rack  

 

Doctors   E xcuse

 

 

 

Athletes:   u se   t his   f orm   w hen   y ou’re   m issing   p ractice   d ue   t o   a   d octor’s   a ppointment.    

Please   f ill   i t   o ut   a nd   b ring   a   c opy   t o   p ractice   o r   c opy   a nd   p aste   i t   a nd   e mail   i t   t o  

Coach   P aul   @  

j

paul@waukesha.k12.wi.us  

*Failure   t o   p rovide   t his   i nformation   w ill   r esult   i n   a n   u nexcused   a bsence   ( refer   t o   t eam   e xpectations).      

 

Appointment   D ate   _ ___________  

 

Appointment   L ocation/Name   o f  

Facility___________________________________________________________  

 

Doctor’s   N ame_______________________________________________________  

 

Reason   f or   A ppointment:    

(only   p rovide   w hat   y ou   a re   c omfortable   s haring,   n o   p ersonal   i nformation   n eeded.    

Example:   “ I   i njured   m y   l eg”   o r   “ I   a m   i ll”   o r   “ I   h ave   t o   g et   s omething   c hecked   o ut.”)  

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Parent/Guardian  

Signature_________________________________________________________Date_______________