Physical Instructions (Football & Cheer Only)

Every athlete will be required to have a current Physical uploaded in the system. Understanding that schools use a variety of differently formatted Physical Forms, the below Physical Fitness & Medical History Form is provided as an example and identifies the specific basic information that MUST be included on “your” uploaded Physical.

 SECTION I.  This section should be completed by the participant, or participant's parent or guardian.
 Participants Name: (last)_________________________________    (first)_________________________________
 Street Address:  _____________________________________________________________________________________
 City:  _________________________________________________  State:  ______________  Zip:  ______________
 Parent/Guardian Name: (last)________________________________    (first)_______________________________
 Home Phone:  ___________________   Work Phone:  ____________________  Cell Phone:  ___________________
 Email Address: _______________________________________________________________________________________
 In Case of Emergency, contact:
 Name:__________________________  Relationship: ___________________  Phone #: ________________________
 Name:__________________________  Relationship: ___________________  Phone #: ________________________
 SECTION II.  This section MUST be completed only by a Licensed Medical Professional.
 (Please check the following if healthy or note otherwise)
   Height           ____________________
   Weight           ____________________ 
   Eyes             ____________________ 
   Ears             ____________________ 
   Mouth            ____________________ 
   Nose & Throat    ____________________ 
   Respiratory      ____________________ 
   Cardiovascular   ____________________ 
   Neurological     ____________________ 
   Muskoskeletal    ____________________ 
   Dermatological   ____________________ 
   Blood Pressure   ____________________ 
 I hereby certify that I am a licensed state examiner and have examined the above named individual
and understand that he/she will be involved in participation in the Carolina Bowl football, cheer
or band programs.  I hereby swear and attest that this individual is physically fit, and I have
found no medical reason which would prevent this individual from safely participating in this year's
Carolina Bowl activities.  I am therefore clearing this individual for athletic participation without
 Indicate medical profession (MD, DO, NP, RN, etc.): _____________________________________
 Are you licensed in your state to perform physical examinations:    YES        NO
 Dated:  _______________________________________
 Please sign and fill out the following information OR place Official Medical Practice Stamp here:
 Printed Name: ____________________________________ Signature: ____________________________________
 Address___________________________________ City___________________ State_____________ Zip ________
 Phone__________________________________________ Email_________________________________________ 

Question: Can I use the same Physical Form used for participation in school sports this past year?

Answer: Yes, as long as the Physical Form was dated after April 1st, prior to the event. The Physical can NOT be older than 10 months.

Question: What if I have an injury during the school year? Do I have to report it?

Answer: Yes. Report any injury immediately. A Doctor’s clearance notice will be required in order to be approved for play.