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PHYSICAL EXAMINATION PACKET

All exams are to be completed between

June 1 & Labor Day

There are no exceptions to this school requirement FALL ATHLETES ONLY May Submit a Copy of the Completed Physical Exam Form on Three (3) Dates: - June 13, 2013 - July 11, 2013 - August Start Date*

* Date Will Be Specified by the Athletic Department

Students planning on participating in any form of athletics must use the attached physical examination form. All students must complete the medical history portion of the attached physical examination form.

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Economou, Maria Class of 2014 ID#: 14076

MEDICAL PACKET INSTRUCTIONS

Enclosed you will find the following forms: • • • • • • • • Instruction

 sheet

 for

 athletes

 participating

 in

 Fall

 Sports

 ONLY

 (Please

 Read)

  List

 of

 health

 care

 professionals

  Annual

 physical

 examination

 (Once

 printed,

 staple

 pages

 5-­‐11

 {Parts

 A,

 B,

 &

 C}

 together

 to

 avoid

 pages

  becoming

 misplaced.)

  Activity

 restriction

 form

 Part

 C

 (If

 completed,

 LEAVE

 STAPLED

 to

 physical

 exam

 form)

  Medication

 form

 A:

 for

 Acetaminophen

 or

 Ibuprofen

  Medication

 form

 B:

 for

 administration

 by

 the

 nurse

 or

 trained

 delegate

  Medication

 form

 C:

 for

 self-­‐administration

 by

 student

  Asthma

 care

 form

Physical examination: A. This form must be completed and signed by your daughter’s health care professional each year between June 1& the first day of school.** There are no exceptions to this school requirement. The enclosed form is the required form for all potential athletes and is strongly encouraged for all other students. This provides the students with the flexibility to try out for a team anytime during the year without...