IMPORTANT DIRECTIONS FOR ATHLETES (GRADES 7-12) AND THEIR PARENT/GUARDIAN FOR FILLING OUT THE PHYSICAL FORM:

THE CIPPE

Section 1 – Personal and Emergency Information – to be completed by parent/guardian

Section 2- Certification of Parent/Guardian – Parent/guardian must sign on each sport line in which the student will try out for the school year. Parent/guardian must also read and sign the 4 statements at the bottom of this section.

Section 3- Understanding of Risk of Concussion and Traumatic Brain Injury – to be completed by student and parent/guardian and signed by both the student and the parent/guardian.

Section 4- Understanding of Sudden Cardiac Arrest Symptoms and Warning Signs– to be completed by student and parent/guardian and signed by both the student and the parent/guardian.

Section 5 – Health History – to be completed by student and parent/guardian andsigned by both the student and the parent/guardian.

Section 6 – PIAA Comprehensive Initial Pre-Participation Physical Evaluation and Certification of Authorized Medical Examiner – to be completed, signed and dated by the authorized medical examiner. The physical evaluation will be valid for all sports within the school year.

THIS CANNOT BE DONE PRIOR TO JUNE 1ST!!!

If you are having trouble viewing the document, you may download the document.