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Ohio High School Athletic Association …

X__Ohio high School Athletic Association Preparticipation physical EvaluationDATE OF EXAM:_____Page 1 of 4 Name _____ Sex _____ Age _____ Date of Birth _____Grade_____ School _____ Sport(s) _____ Address _____ Phone _____Personal Physician_____ In case of emergency, contact: Name _____Relationship _____ Phone (H) _____(W)_____(Cell)_____(Cell)_____Histo ryThis section is to be carefully completed by the student and his/her parent(s) or legal guardian(s) before participation in interscholastic athletics in order to help detect possible "YES" answers in the space provided.

Page 2 of 4 Physical Examination Form The section below is to be completed by physician or staff after history and consent forms …

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