Printable Ihsa Sport Exam Form The parent signatures must be affixed to the form on pages two 2 and five 5 The student athlete signature must be affixed to pages two 2 and five 5 4 Distribution History Form retained by Physician Healthcare Provider Examination Form and Consent and Release Form signed and returned to member school
View download and print Ihsa Preparticipation Examination pdf template or form online 3 Ihsa Sports Physical Form Templates are collected for any of your needs Consider GU exam if in private setting Having third party present is recommended c Consider cognitive evaluation or baseline neuropsychiatric testing if a history of significant concussion On the basis of the examination on this day I approve this chi ld s participation in interscholastic sports for395 days from this date
Printable Ihsa Sport Exam Form
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On the basis of the examination on this day I approve this child s participation in interscholastic sports for one year Yes No Limited Additional Comments No student athlete may participate in IHSA state series competition unless the student and the Examination Date Physician s Signature The IHSAA under the guidance of the Indiana State Medical Association s Commit tee on Sports Medicine requires that the PPE Form be signed by a physician MD or DO nurse practitioner or physician assistant holding a license to practice in the State of Indiana
IESA Add A Tude Banner Order Form 2023 2024 McKinney Vento Homeless Common Form Form must be accompanied with a letter from the school s Homeless Liaison Mikasa Official Volleyball 2023 2024 Officials Payments 2023 2024 2021 2022 IHSA Sports Physical Form pdf 2021 2022 IHSA Sports Physical Form pdf Sign In Details
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PHYSICAL EXAMINATION FORM The physical examination must be performed on or after 4pril I by a Physician holding an unlimited license to IHS 4 4 C 3 10 practice medicine to be valid for the lowing school year Name PHYS C A I Consider additicaa questions on mote sensitive issues Do you feet Sressed out under a of ptessure Apparent clinical contraindications to practice and can participate in the sport s as outlined on this form A copy of the physical examination findings are on record in my office and can be made available to the school at the request of the parents
Athletic Eligibility A Basic Guide for Schools Students and Parents Physical Evaluation Form En Espanol IHSAA Rule 3 10 requires that Between April 1 and student s first Practice in preparation for interschool athletic participation the student shall have a physical examination by or shall provide certification from a physician IOWA ATHLETIC PRE PARTICIPATION PHYSICAL EXAMINATION Page 1 of 4 Form v112021 IOWA ATHLETIC PRE PARTICIPATION PHYSICAL EXAMINATION Please complete and sign this form with your parents if younger than 18 before your appointment
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https://www.ihsaa.org/sites/default/files/documents/physical_form.pdf
The parent signatures must be affixed to the form on pages two 2 and five 5 The student athlete signature must be affixed to pages two 2 and five 5 4 Distribution History Form retained by Physician Healthcare Provider Examination Form and Consent and Release Form signed and returned to member school
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Printable Ihsa Sport Exam Form - On the basis of the examination on this day I approve this child s participation in interscholastic sports for one year Yes No Limited Additional Comments No student athlete may participate in IHSA state series competition unless the student and the Examination Date Physician s Signature
