Physical Activity Contract 2021-2022 School Year
In 2008, the Iowa Legislature enacted "the Healthy Kids Act," requiring that all students in grades 6–12 engage in physical activity for a minimum of 120 minutes per week in which there are at least five days of school. The law also requires that we monitor how students fulfill this requirement.

At Cedar Valley Catholic Schools, students can fulfill this state mandate through a combination of Physical Education/Wellness classes and through other activities during the school day.  These will result in 120 minutes of physical activity per week.

In addition to the curricular experiences offered at school, students may not be able to fulfill the 120 minute requirement without involvement in other extra-curricular and/or non-school activities. Therefore we are requesting that all families complete this form listing the other activities, which will lead to the completion of this requirement.

Activity Fees will be assessed from the information provided below.
Blessed Maria Assunta Pallotta Middle School
$35 per sport
$70 cap per student
$95 cap per family

Columbus Catholic High School
$45 per activity: athletics, robotics, speech and theatre
Speech and theatre are counted as one activity
$125 cap per student
$250 cap per family


Please fill out the items below, sign (both student and parent/guardian), and return to the school by August 13, 2021.  Each student (Grade 6-12) must complete a separate contract.

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Student Name *
Grade (2021-2022) *
SCHOOL ACTIVITIES which qualify as fulfilling the physical activity component of the law that my student will be involved in during the 2021-2022 school year.  Please select all that apply.  This data will be used to calculate activity fees for the year. *
Required
NON-SCHOOL ACTIVITIES (may include non-school sports teams, gymnastics, dance, individualized exercise program, chores at home or farm etc.) that student will be involved in during the 2021-2022 school year, including description of the activities and estimated time student participates per week: (ie. I attend private dance lessons 2x/week for a total of 100 minutes, and I walk two miles every day for another 150 minutes each week. *
 I would like to purchase a High School Activity Pass.  9-12th grade activity pass: $50.  Free admission to all home activities with purchase of pass.  *Does not include admission to state playoff games.
Clear selection
Signature of Student: typing your name here constitutes your signature *
Signature of Parent/Guardian: typing your name here constitutes your signature *
Date *
MM
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YYYY
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