Transcription of PREPARTICIPATION PHYSICAL EVALUATION -- …
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PREPARTICIPATION PHYSICAL EVALUATION -- …
PREPARTICIPATION PHYSICAL EVALUATION -- MEDICAL HIS TORY REVISED 12-4-14 This MEDICAL HISTORY FORM must be completed annually by parent (or guardian) and student in order for the student to participate in athletic activities. These questions are designed to determine i f the student has developed any condition which would make i t hazardous to participate in an athletic event. Student's Name: (print) Sex Age Date of Birth Address Phone Grade School Personal Physician Phone In case of emergency, contact: Name Relationship Pho
PREPARTICIPATION PHYSICAL EVALUATION -- MEDICAL HISTORY REVISED 12-4-14 This MEDICAL HISTORY FORM must be completed annually by parent (or guardian) and student in order for the student to participate in athletic activities.These questions are designed to determine if the student has developed any condition which would make it …
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