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The Coey Communicator

Confirmation Sheet for Physical Activity Hours

HOME

 

École secondaire

REYNOLDS

Secondary School

 

 

 

3963 BORDEN STREET, VICTORIA, BC  V8P 3H9

Telephone:  (250) 479-1696     FAX:  (250) 479-6677

www.members.home.net/reynoldsschool

email:  reynoldsschool@home.com

 

 

 

 

 

 

Confirmation of Physical Activity

(can be a team, club or individual)

 

 

I would like to confirm that ___________________________ has completed an average of 150 minutes per week of Moderate to Intense physical activity between the dates of ________ and _______.

 

The type(s) of physical activity(ies) engaged in was/were:  

___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

Name of Teacher / Coach or Supervising adult: _________________________ (print clearly)

Contact information of supervisor: 

phone: ______________________  e-mail: ___________________

Performance comments (optional):

___________________________________________________

___________________________________________________

___________________________________________________

___________________________________________________

 

Signature: _______________________________       Date: ________________________