PREPARTICIPATION PHYSICAL EVALUATION …
PREPARTICIPATION PHYSICAL EVALUATION form medical HISTORY This medical HISTORY form must be completed annually by parent (or guardian ) and participant in order for the player to participate in athletic activities. These questions are designed to determine of the student has developed any condition which would make it hazardous to participate in an athletic event. player s Name: (print) _______________________________________ Gender _______ Age ________ Date of Birth ______________________ Address ________________________________________ ___________________________________ Phone_____________________________ Grade __________________ School__________________________________ ________________________ Personal Physician _____________________________________ Phone_____________________________ In case of emergency, contact: Name______________________________ Relationship___________________ Phone (H)___________________ (W)_____________________ Explain Yes answers in the box below**.
PREPARTICIPATION PHYSICAL EVALUATION FORM – MEDICAL HISTORY This MEDICAL HISTORY FORM must be completed annually by parent (or guardian) and participant in order for the player to participate in athletic activities.
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