Preparticipation physical evaluation history form note. Please note this is in addition to the 6th grade physical. Complete the medical eligibility form page 4 and sign page 4. At the bottom of the webpage in the lower left hand side, click the khsaa forms link. Khsaa sports physical form awesome the kentucky high. This form is valid for 365 calendar days from the date of the evaluation as written on page 2. Khsaa forms kentucky high school athletic association.
The physician should keep a copy of this form in the chart for their records. Do not attempt to complete the form on your web browser. Athletic participationphysical examination form parental and student consent and release for middle school level students enrolled in grades. A copy of the physical exam is on record in my office and can be made available to the school at the request of the. Written clearance from a physician, physician assistant, chiropractor, or nurse practitioner is required before any participation in uil practices, games or matches yes yes nosi no 1. Jamboree approval form all sports except football pdf.
To access the student sports physical form, visit the kentucky high school athletic association website. This form is to be filled out by the patient and parent prior to seeing the physician. List any prescription medications that you are currently taking. Khsaa form ge04 high school parental permission and consent rev. Physician and parental permission, khsaa form ms01, rev.
Marfan stigmata kyphoscoliosis, higharched palate, pectus excavatum, arachnodactyly, arm span height, hyperlaxity, myopia, mvp, aortic insufficiency neck. Physician and parental permission, khsaa form ge04, rev. This form is only for students who will be in grades 912 in the current school year. Khsaa form ge04 part 1, physician and parental permission, rev. Kentucky high school athletic association khsaa this is the only form to be accepted as current written documentation concerning a player required to use an inhaler track and fieldcross country medical report form copy and retain this form for future use. Parental and student consent and release high school parental. Nfhs procedures for hosting tournaments with nonbordering states pdf. Do you have any ongoing medical issues or recent illness. Khsaa form ppephysical form page 2, physician exam information rev.
To save the publication to your computer, right click. Physical evaluation form pdf ihsaa guidance on 202021 physical forms ihsaa rule 310 requires that between april 1 and students first practice in preparation for interschool athletic participation, the student shall have a physical examination by, or shall provide certification from, a physician holding an unlimited license to practice. The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. They are caused by a bump, blow, or jolt to the head. Code of acceptable behavior and discipline july 10, 2018 edition aup. Sports physical form fill out and sign printable pdf. A complete history and physical examination must be performed upon a students initial entrance into kshsaa interscholastic athleticscheerleading. A concussion is a brain injury and all brain injuries are serious. Personal physician history ppe preparticipation physical. Kansas state high school activities association pre. Currentyear physical given on or after april 15 of the previous school year medical normal abnormal musculoskeletal normal abnormal appearance.
Have you had a medical illness or injury since your last check up or sports physical. Do you have any concerns that you would like to discuss with your provider. The annual history and the physical examination shall not be taken earlier than may 1 preceding the school year for which it is. Parental and student consent and release high school. Preparticipation physical evaluation page 1 of 3 this completed form must be kept on file by the school. General administrative forms physical,transfer,contract. This part must be completed by an authorized health care. Lhsaa medical historymedical exam form revised 618 pdf. Athletic participationphysical examination form khsaa. Lhsaa site verification list of approved schools new pdf. General administrative forms physical,transfer,contract ge01application for membership pdf ge02new member school information pdf ge04combined parent permission and athletic physical forms english, high school ge04combined parent permission and athletic physical forms spanish, high school ge04ppepre participation physical exam. Form high school parental permission and consent rev. Fill out, securely sign, print or email your kentucky high school sports physical form instantly with signnow.
Athletic participationphysical examination form khsaa form. Athletic participation form parental and student consent and release for high school level grades 912 particieation khs. Khsaa form msoi middle school parent permission and consent rev. By signing this form, al parties agree that they have accuratey competeda sections of the form and have readandagree to the terms of this form as detailed. We understand the evaluation involves a limited examination and the screening is not intended to nor will it prevent injury or sudden death. The student and parentlegal guardian consent to this student receiving a physical examination as required by the khsaa. Khsaa form ppephysical examhistoryphysician clearance grades 612 page 1 of 4 rev. Form 20192020 this form must be signed by all student athletes and parentguardians before the student participates in any athletic or spirit practice or contest each school year.
Marfan stigmata kyphoscoliosis, higharched palate, pectus excavatum, arachnodactyly. Any student wishing to participate on a school athletic team must have a khsaa parental consent form and a khsaa physical examination completed and turned in. By signing this form, aparties agree that they have accuratey competedasections of the form and have readandagree to the terms of this form as detailed. Collect the completed ppe forms with the appropriate signatures on pages 2 5. Ky khsaa high school sports physical form pdf ky khsaa middle school sports physical form pdf primaryplus is a federally qualified health center that serves the northeastern kentucky and southern ohio population. Y khsaa physical form with the physical without a consent.
By signing this form, all parties agree that they have accurately completed all sections of the form and have read and agree to the terms of this form as detailed. Khsaa form ms01 middle school parent permission and consent rev. Stuart pepper middle school new sports physical form. Physician and parental permission khsaa form ge04, rev. It can also be found by doing a internet search for khsaa sports physical form 2019. Has a provider ever denied or restricted your participation in sports for any reason. It can also be found by doing a internet search for khsaa. Khsaa sports physical form awesome the kentucky high school athlete march pdf, picture size 2208x3198 best of khsaa sports physical form from the thousand photos online about khsaa sports physical form, picks the top selections using best image resolution just for you all, and this photos is usually one of photos series in this finest. Khsaa form ppephysical form page 1, student health history rev. References to physician on this form shall reference all permitted providers as.
Middle school khsaa physical form high school khsaa physical form. Complete the physical examination form page 3 and sign the bottom of page 3. Khsaa eligibility rules and parental permission form khsaa. Physician and parontal permission, khsaa form ge04, rev. Forms are provided either as portable document format pdf files, microsoft word documents, or both, all of which can be downloaded into, completed on, and printed out of your computer. Start a free trial now to save yourself time and money. Athletic participationphysical examination form parental and.