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Adapted Exercise Science and Wellness
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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
Phone: (619) 644-7987

If possible, please return the completed forms to me prior to the semester start:

FAX: (619) 668-1612


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.

Last Updated: 03/16/2016
  • Grossmont
  • Cuyamaca
A Member of the Grossmont-Cuyamaca Community College District