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Adapted Exercise Science and Wellness Forms
In order for Grossmont College's Adapted Exercise Program to provide you with a personalized and safe program, we request that you complete a Physician's Clearance for
Adapted Exercise Form and a Health Questionnaire prior to participation in one of our classes. Please complete all areas and questions. The Physician's Clearance for
Adapted Exercise Program requires information and a signature from your doctor. This form may be faxed directly from
your Doctor to the fax number listed on the form. The Health Questionnaire may be mailed or given to me, Kathleen Aylward. All information is kept confidential.
If you have any questions or need any assistance, please do not hesitate to contact me:
Kathleen Aylward
kathleen.aylward@gcccd.edu
Phone: (619) 644-7987
If possible, please return the completed forms to me prior to the semester start:
FAX: (619) 644-7467
OR
ATTN: Kathleen Aylward
Grossmont College
8800 Grossmont College Drive
El Cajon, CA 92020
Thank you for your interest in our program. We look forward to meeting you.
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