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.
Hard copies are also available in the Health Office

                    Updated May 18, 2017