Khsaa physical form pdf

Start a free trial now to save yourself time and money. 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. Athletic participationphysical examination form parental and student consent and release for middle school level students enrolled in grades. Preparticipation physical evaluation history form note. Khsaa eligibility rules and parental permission form bylaw references as of april 30, 2007 khsaa form ge04 rev. Do you have any ongoing medical issues or recent illness. Have you had a medical illness or injury since your last check up or sports physical.

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 sports physical form 2019. The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. Marfan stigmata kyphoscoliosis, higharched palate, pectus excavatum, arachnodactyly, arm span height, hyperlaxity, myopia, mvp, aortic insufficiency neck. This form must be reproduced in order for a copy to travel with respective athlete. Lhsaa medical historymedical exam form revised 618 pdf.

Y khsaa physical form with the physical without a consent. Khsaa form ppephysical examhistoryphysician clearance grades 612 page 1 of 4 rev. Complete the medical eligibility form page 4 and sign page 4. The physician should keep a copy of this form in the chart for their records. Complete the physical examination form page 3 and sign the bottom of page 3. A concussion is a brain injury and all brain injuries are serious. Marfan stigmata kyphoscoliosis, higharched palate, pectus excavatum, arachnodactyly. 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. 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.

Khsaa form high schoo parental permission and consent rev. Kansas state high school activities association pre. Khsaa form msoi middle school parent permission and consent rev. Athletic participationphysical examination form khsaa. Physician and parental permission khsaa form ge04, rev. Form high school parental permission and consent rev. To save the publication to your computer, right click. Physician and parental permission, khsaa form ms01, rev. Physician and parontal permission, khsaa form ge04, rev. 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. Khsaa eligibility rules and parental permission form khsaa. Please note this is in addition to the 6th grade physical.

Athlete information this part must be completed by the. It can also be found by doing a internet search for khsaa. This form is only for students who will be in grades 912 in the current school year. Khsaa forms kentucky high school athletic association. Khsaa form ms01 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. Athletic participationphysical examination form khsaa form. Khsaa form ppephysical form page 2, physician exam information rev. 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. Athletic participation form parental and student consent and release for high school level grades 912 particieation khs. 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.

Have you ever had a stress fracture or an injury to a bone, muscle, ligament, joint, or tendon that caused you to miss a practice or game. We understand the evaluation involves a limited examination and the screening is not intended to nor will it prevent injury or sudden death. This form is valid for 365 calendar days from the date of the evaluation as written on page 2. Khsaa sports physical form awesome the kentucky high.

The student and parentlegal guardian consent to this student receiving a physical examination as required by the khsaa. Lhsaa site verification list of approved schools new pdf. List any prescription medications that you are currently taking. To access the student sports physical form, visit the kentucky high school athletic association website.

General administrative forms physical,transfer,contract. Khsaa form ppephysical form page 1, student health history rev. Stuart pepper middle school new sports physical form. Nfhs procedures for hosting tournaments with nonbordering states pdf.

Sports physical form fill out and sign printable pdf. 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. You will need to bring a physical exam consent form and a khsaa physical form. 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. Parental and student consent and release high school. They are caused by a bump, blow, or jolt to the head. Middle school khsaa physical form high school khsaa physical form.

Parental and student consent and release high school parental. References to physician on this form shall reference all permitted providers as. 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. A complete history and physical examination must be performed upon a students initial entrance into kshsaa interscholastic athleticscheerleading. 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. Collect the completed ppe forms with the appropriate signatures on pages 2 5. 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.

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. Athletic participationphysical examination form parental and. Do not attempt to complete the form on your web browser. Code of acceptable behavior and discipline july 10, 2018 edition aup. Khsaa form ge04 part 1, physician and parental permission, rev. Khsaa form ge04 high school parental permission and consent rev. We cannot proceed with the physical without a consent form signed by the parentsguardians. Preparticipation physical evaluation page 1 of 3 this completed form must be kept on file by the school. Do you have any concerns that you would like to discuss with your provider. Physician and parental permission, khsaa form ge04, rev. Currentyear physical given on or after april 15 of the previous school year medical normal abnormal musculoskeletal normal abnormal appearance. This form is to be filled out by the patient and parent prior to seeing the physician.