A checklist has been provided for your convenience to ensure all
forms have been properly completed and returned to the appropriate school personnel:
Please read all information carefully and completely.
PRIVATE PHYSICALS BY FAMILY DOCTOR:
** To be returned to the nurse:
_____ Completed Student Personal and Emergency Information Form
_____ Completed and signed Certification of Parent/Guardian Form (Section 2). A parent/guardian signature is required in the blocked section next to each probable sport in addition to the other required signatures.
_____ Parent/Guardian and student must read and sign the Understanding of Risk of Concussion and Traumatic Brain Injury Form (Section 3).
_____ Parent/Guardian and student must read and sign the Understanding of Sudden Cardiac Arrest Symptoms and Warning Signs Form (Section 4).
_____ Completed and signed Health History Form with explanation of any YES answers (Section 5).
_____ Completed and signed Physical Exam dated on or after June 1, 2018. Please provide athlete’s name, grade, age, school and all probable sports on the form (Section 6). (May use physical completed prior to June 1st IF re-authorized by physician on or after 6/1/18 – documentation required).
_____ Completed and signed Insurance Waiver Form.
(Insurance must be paid for if buying school insurance before athlete can participate.)
______ Completed and signed PIAA Emergency Card for Athletes.
Please return the entire packet to the Athletic Secretary
(High School Athletic Office) no later than
Thursday, August 9, 2018
Incomplete forms will be returned and may delay player participation