Preparticipation Physical Evaluation - Florida High School Athletic Association printable pdf download

Preparticipation Physical Evaluation - Florida High School Athletic Association

Directions for Boone High School Athletic Physicals

READ ALL DIRECTIONS FIRST

. INCOMPLETE FORMS WILL NOT BE

PROCESSED & YOU WILL NOT BE ALLOWED TO PARTICIPATE IN ANY

PRACTICES OR GAMES.

General Directions

Return all physical forms personally to the

FAXED PHYSICALS CANNOT AND WILL NOT BE ACCEPTED

1. DO NOT COME TO OUR CLASSROOM DURING CLASS TIME.

2. DO NOT slide your physical packet under the door, put it in our mailbox,

give it to any coach, or turn it in to the office.

3. PHYSICALS NOT TURNED IN PROPERLY WILL NOT BE PROCESSED

& YOU WILL NOT BE ELIGIBLE FOR PRACTICE OR GAMES.

Directions for the physical

1. PAGE 1: Parent & student must sign the bottom of the front page of the

physical form.

2. PAGE 2: Fill out name, address, phone number, birth date section. Fill out

history questions completely. If you answer any of the questions “yes” please

explain them on page 3.

3. PAGE 3 : Fill out the insurance information completely. If you have no

insurance please print “NO INSURANCE”

4. PAGE 3: Fill out your name on the top of page 4. At the bottom

a. At the bottom the physician must 1) Check “cleared without

limitations”, 2) sign, 3) date, & 4) stamp the form. If there is no stamp

available the physicians name & phone # must be printed on the

bottom of the form

5. EMERGENCY CARDS: There are 2 emergency cards & BOTH MUST BE

FILLED OUT COMPLETELY

6. Consent and Release from Liability Certificate

a. Read page 2 then

b. The student must sign the top of page 1

write in

the student is

c. The parent must

any sport in which

NOT

allowed to participate in

d. The parent/guardian must print their name on the bottom of page 1

e. The student must sign & print their name on the bottom of page 1

I have read & followed all directions carefully.

_________________________

Student name PRINT

_________________________

Student signature

This student’s physical was accepted & approved by:

Preparticipation Physical Evaluation - Florida High School Athletic Association

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