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.