Dear Parent;

It is important that each student participating in school athletic activities are in good physical condition and be free of any medical problems that could be worsened by such participation.

All athletes are now required to get a physical to be eligible to participate.

Please answer by checking the appropriate choice below, sign this form, and return to the school.

1. _____ I believe my child has no substantial medical/physical problems that would prevent his/her full participation in vigorous school athletics.

2. _____ There may be reason to question whether my child can safely participate fully in school athletics.

3. _____ I do not wish to have my child participate in interscholastic athletic competition.

Please list any special medical or physical problems that your child has which may present a problem.

I assume all risks for injuries resulting from participation.

____________________ ________________________________ __________

Student’s Name Parent Signature Date

Thanks,

Centerville School