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Kawameeh Middle School

 
  • Missing/Unsigned Health History Questionnaire (page 1, History Form)
    • You must explain the reason why you answered “yes” to any question on the Health History Questionnaire (page 1)
  • Physical Examination Form, *Must be documented in numerical terms, e.g. “normal” or “cleared” is not acceptable. (Page 3)
  • Vitals
    • Height/Weight
    • Blood Pressure
    • Pulse
    • Vision (If you have prescription contact lenses or glasses please wear them for your eye exam. If your vision is 20/40 or higher you will need to see an eye care professional for correction)
  • Physical Examination Form is not signed by health care provider (page 3)
  • Physical not dated (bottom of page 4, Clearance Form)
  • Clearance Form is not signed and stamped by health care provider (page 4)
  • Health Care Provider has not signed that they completed the Cardiac Assessment Professional Development Module (bottom of page 4, Clearance Form)
  • Physical will expire before the official start of the season 
  • Missing 90 Day Health History Update Questionnaire
  • Missing/Unsigned Concussion, Sudden Cardiac Death, and Steroid Testing Acknowledgement Form (page 5)


Missing information will cause a delay in clearing you to participate in your sport.

Do not leave any lines blank, including your name, address, and date of birth.    

 

Check your sports physical packet BEFORE YOU HAND IT IN for clearance!