|
DOCTOR'S NOTE |
| Students name:
____________________________________
should not participate in music until ___________________. |
Class periods are an hour long. |
| Rehabilitation activities for class: | Time allotment |
| 1. __________________________________________ | _________________ |
| 2. __________________________________________ | _________________ |
| 3. __________________________________________ | _________________ |
| 4. _________________________________________ | _________________ |
| 5. _________________________________________ | _________________ |
| 6. _________________________________________ | _________________ |
| 7. _________________________________________ | _________________ |
| 8. _________________________________________ | _________________ |
| 9. _________________________________________ | _________________ |
| 10. ________________________________________ | _________________ |
| 11. ________________________________________ | _________________ |
| 12. ________________________________________ | _________________ |
| ________________________________________________ | |
| Doctor name and telephone |