Physicals & Clearance
Sports Physical Clearance Checklist:
___ 1. Checklist page.
____2. Physical Evaluation Form -- must only be done by MD, DO, PNP ( No Chiropractors). (Be sure to mark clearance or not; Exam date needs to be within a year, And doctor’s office stamp are REQUIRED.)
____3. Health History form--complete and sign by parent/guardian and athlete.
____4. Two copies of Emergency and insurance information form (For Athletic Director +coach)
____5. Two copies of student Insurance verification letter (For Athletic Director + coach)
____6. Please provide two copies of current insurance card (For Athletic Director+ coach)
____7. Parent/Guardian Code of Ethics -- Read and sign by parent/guardian.
____8. Athlete code of Ethics-- Read and sign by athlete and parent/guardian.
____9. Waiver of liability and release -- read and sign by parent/guardian and athlete.
____10. Concussion Information Sheet--read and sign by parent/guardian and athlete.
Updated May 18, 2017