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1 of 4 PHYSICAL EXAMINATION FORM The physical examination must be performed on or after April 1 by a Physician holding an unlimited license to practice medicine to be valid for the following school year IHSAA By-Law C 3-10 the following school year IHSAA By-Law C 3-10 2 of 4 IHSAA ELIGIBILITY RULES INDIVIDUAL ELIGIBILITY RULES Grades 9 through 12 ATTENTION ATHLETE Your school is a member of the IHSAA and follows established rules. Preparticipation Physical Evaluation HISTORY FORM Note This...
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These forms are provided for you to fill in. If you need to consult other regulations, review the By-law C3-6. You may fill in your name, address and phone (whichever applies) and the student number in the boxes provided on the form. In the field for “Student Number”, leave blank. You may not indicate both “OF” or “RF”, and you may not omit “J”. Any time your school does not have specific rules for what your school is permitted to test, you will be asked to bring this form to your school administrator. YOU CANNOT COMPLETE A CROSS-CHECK ON THIS FORM. It is the responsibility of the parent to submit this form, indicating that they were authorized to do so. If you think you may have the same child in several schools, you must request a copy for each of those school(s) at least 1 month before testing. You should include each school's name, address and phone number on the form and include the address and phone number of the student at the other school you attended to ensure a proper referral is made. You should also supply, as your signature, the following statement “I agree that my child's information is not to be shared with other school officials without parental consent of the parent of the student (which I guarantee you will not share with anyone who will not be authorized by the parent).” This form remains the sole property of the IH SAA and may not be given or sold to anyone. If you wish to have your physical evaluation in writing, you may utilize one of these forms: 1. This form is provided by the IH SAA and must be signed by the student and accompanied by the parent. 2. The IH SAA allows for parental signatures on this form only for the following reasons: 1- The parent and student cannot be known to each other. 2- The parent signed the original parent's name in the parent's own handwriting. 3- The parent did not have a copy of the original parent's signature on hand for this specific form. 3a- IH SAA by-law C3-6(a). 4. The IH SAA allows a parent's signature on the form for the following reasons: 1- The parent was unable to attend the physical evaluation.
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