Sports Physical Clearance Checklist
P1. Checklist page
P 2. Physical Evaluation Form -- must only be done by MD, DO, PNP ( No Chiropractors).
P 6/7. Complete copy #2 Emergency and insurance information form & student insurance verification letter
( For Coach ) **** Please attach one copy of current insurance card ***
P 8. Athlete code of Ethics-- Read and sign by athlete and parent/guardian.
P 9. Parent/Guardian Code of Ethics -- Read and sign by parent/guardian.
P 10. Waiver of liability and release -- read and sign by parent/guardian and athlete.
P 11. Sudden Cardiac Arrest information Sheet—read and sign by parent/guardian and athlete.
P 12/13. Concussion Information Sheet--read and sign by parent/guardian and athlete.
Student will NOT be cleared to participate in sports without Health Office clearance.
SEE ATTACHED FOR ALL FORMS
Hard copies are also available in the Health Office
PLEASE RETURN ALL COMPLETED FORMS TO THE HEALTH OFFICE