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.

 PHYSICAL FITNESS & MEDICAL HISTORY FORM
  
 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
limitation.
  
 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.